Social Occupational Functioning Research Articles

Individual placement and support focusing on employment and education for young people at clinical high risk of psychosis: A feasibility study.

This study aimed to assess the feasibility of implementing Individual Placement and Support (IPS) with a focus on educational and employment goals, within a clinical service for the early detection of individuals at clinical high risk (CHR) of psychosis. Between June 2019 and April 2021, participants were recruited and received up to 6 (± 2) months support. Primary outcome: Enrolled participants, attended sessions, and disengagement rates were analyzed to assess feasibility. Enrollment in mainstream education or/and employment, hours spent working or/and studying, salary, level of functioning, and self-efficacy at baseline and follow-up were compared. Thirty-one participants were recruited, 13 of whom were remotely recruited after the first COVID-19 lockdown. Dropout rates were relatively low (16.1%), and 26 participants (83.9%) completed the program. Each participant received on average nine sessions (M = 9.65; SD = 4.92). Secondary outcomes: At follow-up, 73.1% participants were employed, working on average more hours per week, t(25) = -2.725; p = .012, and were earning significantly more money, t(25) = -3.702; p = .001, compared to baseline. Gains in educational outcomes were less clear. Global Assessment of Functioning, t = 248.50; p = .001, and Social Occupational Functioning, t(25) = -3.273; p = .003, were significantly higher at 6-month follow-up compared to baseline. No differences were found in participants' self-efficacy. Findings indicate that research procedures are appropriate and that IPS implementation within a CHR clinical team is feasible. Secondary outcomes also suggest that IPS may be a beneficial intervention for young people at CHR. A longer follow-up might be needed to assess its impact on educational outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The tertiary service for psychosis: Holistic recommendations for people with complex psychosis.

To describe (i) the clinical characteristics of individuals referred to the Tertiary Referral Service for Psychosis (TRSP) and (ii) the recommendations TRSP made for future treatment across psychopharmacological and other intervention domains. Retrospective audit of clinical data collected during the assessment process of individuals who accessed TRSP between 02/06/2020 and 31/12/2022. Categories of recommendations made following collaborative care planning comprised psychopharmacological, neuropsychological, psychological, psychosocial, physical health, substance misuse and other domains. Eighty-two individuals were included, with diagnoses most commonly of schizophrenia (54.9%) and schizoaffective disorder (30.5%). The median PANSS score was 88.0 (73-100). Social occupational functioning was very poor (SOFAS M = 37.0, SD = 15.1). Cognitive functioning was poor (RBANS: M = 74.6; SD: 15.0). 67.1% had physical health comorbidities, with high prevalence of smoking (52.4%) and substance misuse (25.6%). Psychopharmacological recommendations (made for 81.7%) included clozapine trial (25.6%), clozapine dose change/augmentation (22.0%) and rationalisation of polypharmacy (12.2%). Neuropsychological (73.2%), psychological (39.0%) and psychosocial (85.4%) recommendations included access to cognitive remediation, psychological therapy and disability support. Physical health and substance misuse interventions were recommended for 91.5% and 20.7%, respectively. Individuals referred to the TRSP had marked clinical and functional impairments. Holistic collaborative care planning complemented psychopharmacological interventions with psychological, psychosocial and physical healthcare recommendations.

Psychotic symptoms and neurocognition among patients with major depressive disorder: A chained mediation model of depressive symptoms and socio-occupational functioning

BackgroundDepressive symptom and psychotic symptom have been identified as risk factors for impaired socio-occupational functioning in patients with major depressive disorder (MDD), while neurocognitive functioning is considered to be a potential protective factor against socio-occupational functioning. Nevertheless, little is known about the complex relationship among these factors in patients with MDD. The purpose of this research was to explore whether the relationship between depressive symptom severity and social-occupational functioning is mediated by neurocognitive functioning and psychotic symptom severity in MDD patients. MethodsA total of 659 eligible MDD patients included male and female, and their depressive symptoms and psychotic symptoms at baseline were assessed by the 17-item Hamilton Depression Scale (HAMD-17) and The Brief Psychiatric Rating Scale (BPRS) respectively. Cognitive domains were assessed by the MATRICS Consensus Cognitive Battery (MCCB), and subjective and objective functioning were measured by the Global Assessment of Functioning (GAF). LimitationThe analysis is cross-sectional, which limits causal inference. Result(1) The correlation between depressive symptoms and thought disturbance was positive (r = 0.125, p = 0.001), whereas the correlations with visual learning and memory (r = −0.146, p < 0.001) and socio-occupational functioning (r = −0.175, p < 0.001) were negative. (2) Depressive symptoms mainly affect the socio-occupational functioning of MDD patients via three indirect effects: the single mediating effect of psychotic symptoms and neurocognitive functioning, and the chain mediating effect of psychotic symptoms and neurocognitive functioning. ConclusionsThe results suggest that the relationship between depressive symptom severity and socio-occupational functioning in MDD patients is partially mediated by psychotic symptom severity and neurocognitive functioning.

Longitudinal changes in neural gain and its relationship to cognitive control trajectory in young adults with early psychosis

The mixed cognitive outcomes in early psychosis (EP) have important implications for recovery. In this longitudinal study, we asked whether baseline differences in the cognitive control system (CCS) in EP participants would revert toward a normative trajectory seen in healthy controls (HC). Thirty EP and 30 HC undertook functional MRI at baseline using the multi-source interference task—a paradigm that selectively introduces stimulus conflict—and 19 in each group repeated the task at 12 months. Activation of the left superior parietal cortex normalized over time for the EP group, relative to HC, coincident with improvements in reaction time and social-occupational functioning. To examine these group and timepoint differences, we used dynamic causal modeling to infer changes in effective connectivity between regions underlying the MSIT task execution, namely visual, anterior insula, anterior cingulate, and superior parietal cortical regions. To resolve stimulus conflict, EP participants transitioned from an indirect to a direct neuromodulation of sensory input to the anterior insula over timepoints, though not as strongly as HC participants. Stronger direct nonlinear modulation of the anterior insula by the superior parietal cortex at follow-up was associated with improved task performance. Overall, normalization of the CCS through adoption of more direct processing of complex sensory input to the anterior insula, was observed in EP after 12 months of treatment. Such processing of complex sensory input reflects a computational principle called gain control, which appears to track changes in cognitive trajectory within the EP group.

Assessment of social functioning, quality of life, and social support in persons with schizophrenia

Context: The outcome of schizophrenia (SZ) is impaired psychosocial functioning and poor quality of life (QOL) which is associated with burdens and societal expenditure to the caregivers. Aims: This study was aimed to access the difference in social occupational functioning, QOL, and social support between male and female patients with SZ. Settings and Design: This is a cross-sectional observational study conducted on persons with SZ visiting the psychiatry outpatient department in a tertiary care teaching institute. Materials and Methods: The sample consisted of N = 200 persons with SZ (International Classification of Diseases-10) aged 21–45 years of both genders. The assessment of socio-occupational functioning, QOL, and social support with administering the Social Occupational Functioning Scale (SOFS), World Health Organization Quality of Life-BREF Scale, and PGI Social Support questionnaire. Statistical Analysis: A Chi-square test was applied for discrete variables and a t-test for continuous variables. An independent sample t-test was used to assess differences between the males and females. Results: Overall, males were more educated than females. Occupationally, there was a significant difference between males and females (P = 0.000). A significant difference (P = 0.000) was found between males and females on total socio-occupational functioning and social support (P = 0.000). The difference between males and females on QOL was observed on perceived physical health (P = 0.000) and psychological health (P = 0.039). Conclusions: This study confirms that there is a definite gender difference in SZ on psychosocial and QOL. Males were physically, psychologically healthier and had better socio-occupational functions as well as strong social support compared to females.

Thought Disorder as a Neglected Dimension in Schizophrenia.

Thought disorder (TD) is one of the main symptom domains of schizophrenia. TD is a construct that can be seen in both acute and chronic periods in patients with schizophrenia. It is associated with a poor prognosis and relapses, and it disrupts social-occupational functioning. TD also shows a strong familial aggregation and increases the risk of transition to schizophrenia in subjects with ultra-high risk. Although TD was once thought to be pathognomonic to schizophrenia, now it is known that it is a transdiagnostic symptom that is seen not only in schizophrenia but also in other psychiatric disorders. This article reviews the concept of thought disorder in terms of its history, clinical evaluation, neurocognitive features and clinical course in patients with schizophrenia.

Supported employment programme for persons with severe mental disorders in India: A feasibility study.

A number of persons with severe mental illnesses are unable to prepare for, find or keep a job due to factors linked to their illness as well as psychosocial issues. To test the feasibility of a supported employment programme to help persons with severe mental disorders obtain and sustain employment. A supported employment programme was developed for persons with severe mental disorders with components of (a) assessment of vocational potential, (b) vocational counselling, (c) networking and liaison with prospective employers, (d) job-related training and placement and (e) continued support for 6 months. Job placement status, social occupational functioning and disability (quantitative data) and benefits of enrolling in the employment programme (qualitative data) were assessed. A total of 40 employers were liaised with for providing job placement and reasonable accommodation. Out of 63 participants recruited into the study, 32 (50.8%) participants were placed in competitive jobs, placement was actively attempted for 17 (27.0%) participants, 7 (11.1%) were referred for skill training and 7 (11.1%) dropped out from the study. The disability score significantly reduced and socio-occupational functioning significantly improved in those who were placed over a period of 6 months. The supported employment programme was found to be feasible as it showed good placement rates and improvement in socio-occupational functioning and disability scores.

M240. THE RELATIONSHIP OF TREATMENT DELAY WITH PERSONALITY TRAIT AND FAMILY COHESION IN PATIENTS WITH FIRST-EPISODE SCHIZOPHRENIA SPECTRUM DISORDER

BackgroundDuration of Untreated Psychosis (DUP) is one of the important factors that affect the prognosis of schizophrenia. This study aimed to investigate the effects of personality trait and family relationships on delayed treatment of schizophrenia.MethodsThe subjects were 169 patients diagnosed with first-episode schizophrenia. It is a prospective study examined the socio-demographic factors with positive and negative syndrome (PANSS) and social occupational function (SOFAS). Personality trait was investigated with the Big Five Inventory (BFI-10) and family cohesion was investigated with the Family Adaptability and Cohesion Evaluation Scales-III (FACES-III). The DUP was defined as the time period from the appearance of the first psychotic symptoms for more than several days to the time when antipsychotic treatment began. Groups were divided according to the median value of the DUP.ResultsThe average DUP was 12.0 months and the median value was 3.0 months. In long DUP group, age is significantly older, the PANSS score was significantly higher and the SOFAS score was significantly lower. Logistic regression analysis showed that long DUP was associated with the conscientiousness of the BFI-10 (OR = 2.175, p = 0.004) and lower level of family cohesion of FACES-III (OR = 0.930, p = 0.025).DiscussionAs a result of the study, treatment delay of psychosis was associated with lower cohesion and adaptability of family function and the tendency of the personality with conscientiousness. These suggest that the role of the family in accessing mental health services is important when the initial symptoms of schizophrenia develop.

Schema modes as a common mechanism of change in personality pathology and functioning: Results from a randomized controlled trial

ObjectiveWe aimed to empirically test whether schema modes are central to the change process in schema therapy, clarification-oriented psychotherapy, and treatment as usual, i.e., predictive of personality pathology, and global and social-occupational functioning. MethodA multicenter randomized controlled trial was conducted (N = 139 men, N = 181 women) over the course of three years. Repeated assessments of schema modes, personality disorder (PD) severity and functioning (controlled for concurrent PD-pathology) were analyzed using a multilevel autoregressive model. Variables were person-centered to ensure that within-person changes were analyzed. Through a process of backward elimination, the schema modes predictive of the dependent variable (i.e., PD-severity and functioning) at a later point in time were identified while controlling for concurrent dependent variable levels. Bidirectionality was tested by assessing whether dependent variables predicted later schema modes. ResultsThe Healthy Adult, Vulnerable Child, Impulsive Child, and Avoidant Protector predicted later personality pathology, with no bidirectionality observed for the first two. The Healthy Adult and Self-Aggrandizer predicted functioning at a later point in time, with no bidirectionality for Self-Aggrandizer. There was no moderation by treatment type for PD symptomatology, except for Self-Aggrandizer, which predicted functioning only in schema therapy. ConclusionsThe Healthy Adult and Vulnerable Child are central to the change process and appear to reflect common mechanisms of change. The Self-Aggrandizer might reflect a change mechanism specific for schema therapy. Our findings support the recent emphasis on these modes in schema therapy.

Study Of The Functioning Level In People Having Psychosocial Disabilities

Introduction: Mental health is state of wellbeing in which as individual realizes in his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO, 2004). Schizophrenia is a significantly disabling disease that affects social family psychological, vocational and occupational functioning (Lyngdoth, L. et al, 2016). Depressive disorders often start at a young age; they reduce people’s functioning and often are recurring (Marcus et al., 2012). Studies have shown decreased functioning ability in people having mental illness in Nepal. This study was done to explore the impact of mental illness in their daily functioning abilities. &#x0D; Material And Method: A cross-sectional survey was conducted among 120 people suffering from mental illness (psychosocial disabilities) for more than six months. Mental health social workers who were facilitating mental health self-help group of treatment seeking mental health patients in the health facilities were trained and supervised during data collection. Selected participants were informed about research objectives and received consent for the study. Nepali adopted WHO-DAS-2 (Thapa et al, 2005) was used to collect both demographic and functioning abilities of research participants. Data were analysed using SPSS 20th version mainly for descriptive statistics. &#x0D; Results: Participants' age ranged from 18-60 years with mean age 29.53 (SD±10.8), with gender distribution 58.3% female and 41.7% male. People with psychosocial disabilities experienced in an average 9.45 days difficulty, average 6.95 days they couldn't do daily work and minimized work for average 3.55 days in the month. Female with mental health problems experienced more difficulties in daily life functioning (S1-S12 items in WHO-DAS) where moderate to severe level difficulties observed than male with mental health problems. Emotional effect due to health problems, talking with unknown people, difficulties in friendship area and doing daily activities were affected significantly statistically (p=0.01, 0.05, 0.04 and 0.02). Ethnicity and gender is significantly correlated with total affected days (r=.221, -.180 p= 0.05, table 3). Gender and total affected working days is correlated but not significant statistically. &#x0D; Conclusion: Level of functioning is affected significantly in people having psychosocial disabilities; impairment is higher in female, people suffering with severe form of mental illness. Findings indicate need of awareness in mental health. Further research is necessary in larger and representative population including care-taker of mentally ill person.

Effects of an epilepsy-specific Internet intervention (Emyna) on depression: Results of the ENCODE randomized controlled trial.

Depression and anxiety are highly prevalent among people with epilepsy (PwE) but often remain unrecognized and treated inadequately. Effective psychosocial treatments such as cognitive behavioral therapy (CBT) are rarely available to most PwE, which is one reason electronically delivered CBT (eCBT) is regarded as promising. This study examined an eCBT intervention, termed Emyna, that was tailored to suit the needs of PwE. It includes CBT-related content on depression, stress and anxiety, seizure triggers and auras, and lifestyle habits. The trial examined the efficacy of Emyna in reducing symptoms of depression (primary outcome) and anxiety as well as improving quality of life. Participants (N=200) with epilepsy, a diagnosis of a depressive disorder, and at least moderate depressive symptoms were randomized to Emyna or care as usual. At baseline and after 3, 6, and 9months, participants were invited to complete online questionnaires. The primary outcome was improvement of depressive symptoms at 3months. Relative to the control group, intervention group participants experienced significantly greater improvements in depression, anxiety, stress, social-occupational impairment, and epilepsy-related quality of life, in both intention-to-treat (ITT) and per-protocol analyses. In ITT analyses, effects of medium magnitude were observed, as measured by the Patient Health Questionnaire-9 items (Cohen d=0.54, 95% confidence interval [CI] = 0.25-0.82, P<0.001) and the Neurological Disorders Depression Inventory for Epilepsy (d=0.51, 95% CI = 0.23-0.79, P<0.01). At 3months, intervention group participants also reported fewer illness-related days off work and fewer days hospitalized over the preceding months, compared to control group participants (P≤0.05), whereas no such differences were present at baseline (P>0.30). These findings showed that Emyna, used adjunctively to usual care, could help improve mental health, social-occupational functioning, and quality of life among PwE. The program provides an additional treatment option that could produce clinically relevant symptom reductions and reduce key cost drivers (ie, hospitalization rates and illness-related inability to work).

Mediating effect of neurocognition between severity of symptoms and social-occupational function in anxious depression.

Major depressive disorder (MDD) is associated with neurocognitive impairment and reduced social-occupational function. However, neurocognition and social-occupational function in patients with anxious depression have been under-investigated. An increasing number of studies have demonstrated that neurocognition plays an important role in social-occupational function. The objective of this study was to investigate the association of severity of symptoms, neurocognition and social-occupational function in patients with anxious depression. Using a cross-sectional design, 214 patients with MDD were recruited consecutively and evaluated using the 17-item Hamilton Depression Rating scale (HAMD-17), the MATRICS Consensus Cognitive Battery (MCCB) and the Global Assessment of Functioning (GAF). The prevalence of anxious depression in MDD patients was 64.5%. Compared to non-anxious subjects, the anxious group had more severe symptoms. Moreover, in the anxious group, social-occupational function was associated with several domains of symptoms and neurocognition, while social-occupational function was associated with only one aspect of depressive symptoms (cognitive disturbance) in the non-anxious group. In addition, there was a mediating effect of neurocognition on the association between the severity of symptoms and social-occupational function in the anxious group. The major limitation of the present study is the use of a cross-sectional design that is unable to illuminate causal relationships. Our results suggest that the severity of symptoms is negatively associated with neurocognition and social-occupational function and that neurocognition is positively associated with social-occupational function in patients with anxious depression.

Patterns and predictors of trajectories for social and occupational functioning in patients presenting with first-episode non-affective psychosis: A three-year follow-up study

BackgroundFunctional impairment is prevalent in patients with first-episode psychosis (FEP). Longitudinal course of functioning in the early stage of psychotic illness is under-studied. In this report, we aimed to investigate the patterns and baseline predictors of social-occupational functional trajectories over 3 years, utilizing growth mixture modeling (GMM) analysis, in a large representative Chinese young FEP cohort in Hong Kong. MethodSix hundred seventeen consecutive patients aged 15–25 years presenting with first-episode non-affective psychosis to a specialized early intervention service were studied. Data on demographic, pre-treatment and baseline clinical characteristics were collected. Individual class membership of functioning derived from GMM was based on ratings on Social and Occupational Functioning Scale (SOFAS) measured at five different time-points (baseline, 6, 12, 24 and 36 months) across 3-year follow-up. ResultsFour distinct functional trajectories were identified including persistently poor (48.1%, n = 320), early improved (31.3%, n = 203), gradually improved (14.8%, n = 69) and improved-deteriorated (5.8%, n = 25) trajectories. Multinomial regression analysis revealed that male gender, lower educational attainment, a diagnosis of schizophrenia-spectrum disorder and a receipt of inpatient treatment upon initial presentation independently predicted persistently poor trajectory membership. ConclusionThe current study reveals a heterogeneous course of social-occupational functioning in FEP. Our finding that approximately half of the patients displaying persistently poor trajectory over 3 years indicates functional impairment as an unmet therapeutic need in early illness phase. Further research applying individual-based trajectory analysis in FEP is warranted to facilitate better characterization of longitudinal patterns of functioning and development of targeted intervention to promote early recovery.

Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system

A critical research goal is to identify modifiable risk factors leading to functional disabilities in young psychiatric patients. The authors developed a multidimensional trans-diagnostic predictive model of functional outcome in patients with the recent-onset of a psychiatric illness.Baseline clinical, psychosis-risk status, cognitive, neurological-soft-signs measures, and dopamine-related-gene polymorphisms (DRD1-rs4532, COMT-rs165599, and DRD4-rs1800955) were collected in 138 young non-psychotic outpatients.116 individuals underwent follow-up (mean=2.2years, SD=0.9) examination. A binary logistic model was used to predict low-functioning status at follow-up as defined by a score lower than 65 in the social occupational functioning assessment scale.A total of 54% of patients experiences low functioning at follow-up. Attention, Avolition, and Motor-Coordination subscale were significant predictors of low-functioning with an accuracy of 79.7%. A non-significant trend was found for a dopamine-related-gene polymorphism (DRD1-rs4532). The model was independent of psychotic-risk status, DSM-diagnosis, and psychotic conversion.A trans-diagnostic approach taking into account specific neurocognitive, clinical, and neurological information has the potential to identify those individuals with low-functioning independent of DSM diagnosis or the level of psychosis-risk.Specific early interventions targeting modifiable risk factors and emphasize functional recovery in young psychiatric samples, independent of DSM-diagnosis and psychosis-risk, are essential.

The effect of cognitive training on evoked potentials in schizophrenia

Electrophysiological indices are sensitive to cognitive dysfunction in schizophrenia but have rarely been used to assess benefits of cognitive remediation. Our aim was to evaluate the effect of specific cognitive training approaches on event-related potentials.Forty-six patients with schizophrenia underwent either auditory (AUD) or visuo-spatial (VIS) cognitive training or treatment-as-usual (TAU). Cognitive training was computer-assisted and administered for 10 sessions within two weeks. Event-related potentials during an active odd-ball paradigm together with clinical and neuropsychological variables were assessed before and after training and again at a two-month follow-up.Compared to the TAU group both the AUD and VIS training groups showed decreased P2 latency following training. At follow-up, the P2-latency reduction was stable in the VIS group but the AUD group experienced a relapse. Training resulted in improved digit-span backward among neuropsychological variables. Increased P2 amplitude was related to more positive symptoms and lower social-occupational functioning and longer P2 latency was associated with greater severity of stereotyped thinking.The more general visuo-spatial training appears to have a longer-lasting effect on P2 latency than the specific auditory training. Alternatively, there may be specific auditory discrimination deficits in schizophrenia requiring more extensive training for a stable change.

Support for Wellness Achievement Programme (SWAP): clinical and demographic characteristics of young people with at-risk mental state in Singapore.

Individuals with at-risk mental state (ARMS) experience subtle changes in thinking, behaviour and emotion before their first psychotic episode. Research has shown intervention provided during this period could delay, reduce, or even prevent the conversion to psychosis. In March 2008, the Support for Wellness Achievement Programme (SWAP) was launched for the assessment and treatment of patients with ARMS in Singapore. This paper examines the sociodemographic and clinical characteristics of patients at baseline. In total, 384 patients were screened and 155 were accepted into the service. All patients were evaluated using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Severity of psychopathology was assessed by Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and levels of functioning were assessed using the Social and Occupational Functioning Assessment Scale (SOFAS). The mean age of the patients was 21.0 years (standard deviation (SD) = 3.5) and 69.7% were men, 42.6% had a relative with a mental health problem and 69.8% met the criterion solely for the attenuated symptoms group. The mean PANSS total score was 48.9 (SD = 10.8). There was also a high rate of comorbidity with 34.8% having depression and 20.0% had anxiety disorders. The mean baseline SOFAS score was 51.5 (SD = 9.8), indicating moderate impairment in their functioning. These preliminary findings have highlighted that our data are similar to other ARMS programmes, and in addition to the management of ARMS, there is a need to treat both the comorbidities and impairment in social occupational functioning.

Outcome in early-onset schizophrenia revisited: Findings from the Early Psychosis Prevention and Intervention Centre long-term follow-up study

Objective To compare the long-term outcome in individuals with early-onset (before age 18) and adult-onset schizophrenia spectrum disorder who were initially diagnosed and treated in the same clinical center. Method A prospective follow-up study of 723 consecutive first-episode psychosis patients (age range 14 to 30 years) on average 7.4 years after initial presentation to an early psychosis service, the Early Psychosis Prevention and Intervention Centre in Melbourne, Australia. The outcome measures included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Negative Symptoms, the Beck Depression Inventory, the Global Assessment of Functioning Scale, the Social and Occupational Functioning Assessment Scale, and the Quality of Life Scale. Results Follow-up interviews were conducted on 66.9% (484/723) individuals, of whom 75.6% (366/484) received a schizophrenia spectrum disorder diagnosis at baseline. Early-onset schizophrenia spectrum disorder was observed in 11.2% (41/366). At follow-up, individuals with early-onset reported significantly fewer positive symptoms and were characterised by significantly superior functioning on measures assessing global functioning, social-occupational functioning, and community functioning than individuals with adult-onset. The early-onset group also achieved significantly better vocational outcomes and had a more favourable course of illness with fewer psychotic episodes over the last two years prior to follow-up. Finally, when investigated as a continuous variable, younger age at onset significantly correlated with better symptomatic and functional outcomes. Conclusions These results question the assumption that early-onset schizophrenia typically has a poor outcome. Early detection and specialised treatment for the first psychotic episode appear to be more effective at improving long-term functional outcomes in people with early-onset schizophrenia as in those with adult-onset schizophrenia. This possibility and the reasons for it need further investigation.

Short-Term Psychodynamic Psychotherapy for Somatic Disorders

Background: Somatic symptom disorders are common, disabling and costly. Individually provided short-term psychodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for somatic symptom disorders has not been reviewed. Methods: We undertook a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation. Results: A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symptoms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls. Conclusion: STPP may be effective for a range of medical and physical conditions underscoring the role of patients’ emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and costs.

Disability and posttraumatic stress disorder in disaster relief workers responding to september 11, 2001 World Trade Center Disaster

Empirical evidence suggests that social and occupational disability plays a significant role in posttraumatic stress disorder (PTSD). The purpose of this study was to assess the role of social/occupational disability and to identify predictors of the development of PTSD in a group of disaster relief workers (DRWs) who had been deployed to the World Trade Center (WTC) following September 11, 2001. Eight hundred forty-two utility workers completed a battery of comprehensive tests measuring PTSD and social occupational functioning. Results indicated a significant association between PTSD symptoms and impaired social/occupational functioning. Symptomatic workers were also more likely to have a history of trauma, panic disorder, and depression. Those with a history of trauma, depression, generalized anxiety disorder or panic reported significantly more disability than those without a psychiatric history. Careful screening of PTSD and social/occupational functioning in DRWs following a disaster is warranted so that early treatment can be undertaken to prevent a chronic and disabling course.

A twelve-week randomized controlled study of the cognitive-behavioral Integrated Psychological Therapy program: positive effect on the social functioning of schizophrenic patients

The present study was designed to evaluate the effect of twelve weekly sessions of the cognitive-behavioral program originally known as the Integriertes Psychologisches Therapieprogramm für Schizophrene Patienten, designated the Integrated Psychological Therapy (IPT) program in English, on cognition, social adjustment and quality of life in schizophrenic outpatients, comparing it to the effect of treating such patients as usual. Fifty-six adult outpatients (from 18 to 65 years of age) with ICD-10-based diagnoses of schizophrenia were randomly assigned to two different groups: active intervention (IPT group); and treatment as usual (control group). Outcome measures were quality of life (as determined using the WHOQOL-Bref), cognition (Mini-Mental State Examination and Word Recall Test), global functioning (DSM-IV Global Assessment of Functioning Scale), social functioning (Social and Occupational Functioning Assessment Scale) and social adjustment (Social Adjustment Scale). The findings suggest that, in comparison with treatment as usual (control group), the twelve-session IPT program had a positive effect on several outcome measures: cognition in the domains of spatiotemporal orientation (p = 0.051) and memory (p = 0.031); overall social adjustment (p = 0.037), leisure/social life (p = 0.051) and family relations (p = 0.008); overall functioning (p = 0.000); social-occupational functioning (p = 0.000); and quality of life in the psychological domain (p = 0.021). The twelve-session cognitive-behavioral IPT intervention demonstrated superiority over treatment as usual in its effects on cognition, social adjustment and quality of life. Studies involving larger samples, longer follow-up periods and additional outcome measures are needed in order to assess the specific effects on dimensions of social functioning, cognitive functioning and quality of life in patients with schizophrenia.