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Benefits of Cognitive Remediation and Supported Employment for Schizophrenia Patients With Poor Community Functioning
Morris D. Bell, Ph.D., A.B.P.P.; Kee-Hong Choi, Ph.D.; Christina Dyer, Psy.D.; Bruce E. Wexler, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200505
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Dr. Bell, Dr. Dyer, and Dr. Wexler are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: morris.bell@yale.edu). Dr. Bell and Dr. Dyer are also with the VA Connecticut Healthcare System, West Haven. Dr. Wexler is also with the Connecticut Mental Health Center, New Haven. Dr. Choi is with the Department of Psychology, Korea University, Seoul.

Copyright © 2014 by the American Psychiatric Association


Objective  This study was conducted to determine whether augmenting supported employment with cognitive remediation can improve vocational outcomes and whether augmentation is more important for participants with lower community functioning.

Methods  In this secondary analysis of data from two related, single-blind, randomized controlled trials, 175 participants with schizophrenia or schizoaffective disorder received supported employment or supported employment plus cognitive remediation and were classified into higher or lower community functioning according to a median split of their quality-of-life scores at baseline. Participants received one year of active intervention and follow-up a year later. Primary outcome measures were competitive employment rates and total hours of work.

Results  Employment rates over two years for participants with lower community functioning were significantly different for the two conditions (supported employment=20%, plus cognitive remediation=49%, p<.005), whereas participants with higher functioning showed equivalent rates of employment (62% versus 54%, ns). Among lower-functioning participants, those who received cognitive remediation also worked significantly more hours over two years than those who received supported employment only, but higher-functioning participants worked similar amounts of hours in both conditions. Improvements in cognitive functioning and intrinsic motivation were related to employment outcomes but only for the lower-functioning group in the supported employment plus cognitive remediation condition, suggesting possible mechanisms for the observed effects.

Conclusions  Augmenting supported employment with cognitive remediation may boost vocational outcomes for participants with lower community functioning but may not be necessary for those functioning better in their communities.

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Table 1Design elements for original and continuation studiesa
Table Footer Note

a IPS, individual placement and support; MCCB, MATRICS Consensus Cognitive Battery; PANSS, Positive and Negative Syndrome Scale

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Table 2Characteristics of participants with schizophrenia and lower or higher functioning in their community and who received supported employment only or augmented by cognitive remediation
Table Footer Note

a Positive and Negative Syndrome Scale; higher scores indicate greater symptom severity. Possible total scores range from 30 to 210. Possible scores for each domain are as follows: positive, 6–42; negative, 8–56; cognitive, 7–49; hostility, 4–28; emotional discomfort, 4–28.



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