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Successful vocational functioning in schizophrenia
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Ratings (RRA) as a predictor of successful rehabilitation outcome in subjects with chronic schizophrenia. Methods: As part of their clinical treatment, 32 schizophrenic patients attending a continuing day treatment program participated in a Rehabilitation Assessment Group for eight one hour sessions in which each subject's readiness to set a goal in the environments of living, learning, working and socializing was assessed. Six months later, each subject was interviewed to determine the degree to which changes had been accomplished in these four environments. Results: There was a statistically significant positive correlation between the degree of expressed rehabilitation readiness with a particular environment in patients ' lives and their ability to effect a change. There was no correlation between age, or length of treatment and the degree to which they made a change in that particular environment. Conclusion: These data suggest that a patient's expressed readiness for rehabilitative change is the best predictor of making change. Also, that satisfaction and dissatisfaction is not limited to a single domain but seems to be generalized across the four environments.
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SUCCESSFUL VOCATIONAL FUNCTIONING IN SCHIZOPHRENIA James M. Gold, Nancy L. Bryant, Katalin Vladar, Robert W . Buchanan Maryland Psychiatric Research Center. Department of Psychiatry, University of Maryland. Baltimore M aryland 21228. USA
Follow up studies in schizophrenia have documented successful vocational functioning in 10-30% of patients . However, the neurobiological characteristics associated with vocational outcome remain poorly understood. This exploratory study contrasts the neuropsychological and brain structural characteristics of patients who demonstrate good vocational functioning (GVF), patients with poor vocational functioning (PVF), and healthy controls. The Level of Functioning Scale was used to assess vocational outcome. Comparison of the two patient groups revealed that GVF patients had superior neuropsychological performance, relative to the PVF group, across multiple measures, with moderate to large effect sizes (0.4-1.0). In contrast, the two patient groups did not differ on the degraded stimulus CPT, a putative vulnerability marker, with both groups demonstrating deficits relative to healthy controls. MRI data were examined in 8 GVF, 8 PVF, and 8 controls matched on age, gender, race (all right handed). Both GVF patients and healthy controls demonstrated asymmetries in temporal and frontal lobe volumes (R>L) which were lacking in PVF patients. The results suggests that poor vocational outcome in schizophrenia may be associated with neurodevelopmental factors that impact cortical specialization-lateralization,
whereas GVF patients appear to have a more 'focal' illness, both cognitively and in terms of brain structure.
b31 DISSEMINATING TREATMENT RECOMMENDATIONS FROM THE SCHIZOPHRENIA P.O.R.T. Howard H. Goldman Department ofPsychiatry, University ofMaryland School of Medicine; Baltimore. MD21201. USA
Elizabeth A. McGlynn RAND Corporation. Santa Monica, CA 90406. USA
Here we focus on the dissemination of the Schizophrenia PORT treatment recommendations. The five communities involved in the Schizophrenia PORT data collection were also selected to participate in the plan to disseminate the recommendations, permitting the PORT to track the impact of the effort. In March and April, 1996, providers, patients , and their families in each of the communities were exposed to a one-day continuing education program on a selection of treatment recommendations focusing on psychopharmacology, family interventions, assertive community treatment and inpatient care. In addition, pairs of the communities were involved in supplementary dissemination strategies: for example, 'academic detailing' was used to amplify the dissemination of the psychopharmacologic recommendations during the autumn of 1996 and training in specific techniques of family supportive interventions were begun in June, 1996. The feasibility of these strategies will be assessed, and their impact will be evaluated, examining patterns of pract ice abstracted from clinical records.
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QUALITY OF LIFE IN SCHIZOPHRENIA: AFFILIATIVE AND INSTRUMENTAL DOMAINS Marianne S. Goodman, James W. Hull, Kenneth G. Terkelsen, Thomas E. Smith Department ofPsychiatry, Cornell University Medical College. White Plains. NY 10605, USA
This study of 67 chronically mentally ill outpatients with psychotic disorders examined subjective quality of life scores from Lehman's Quality of Life (QOL) interview. Factor an~Y· ses identified 'Affiliative' and 'Instrumental' constructs which accounted for 67% of the variance in subjective satisfac~on ratings . The results suggest that the global satisfacti~n ratulg may be derived from instrumental ~ncc:rns an~ IS not a summation of individual domain subjective ratings" ,Th~ findings further clarify the concept of life satisfaction 10 this population of severely mentally ill individ?als. and suggest modifications in bow quality of life information IS evaluated.
Ratings (RRA) as a predictor of successful rehabilitation outcome in subjects with chronic schizophrenia. Methods: As part of their clinical treatment, 32 schizophrenic patients attending a continuing day treatment program participated in a Rehabilitation Assessment Group for eight one hour sessions in which each subject's readiness to set a goal in the environments of living, learning, working and socializing was assessed. Six months later, each subject was interviewed to determine the degree to which changes had been accomplished in these four environments. Results: There was a statistically significant positive correlation between the degree of expressed rehabilitation readiness with a particular environment in patients ' lives and their ability to effect a change. There was no correlation between age, or length of treatment and the degree to which they made a change in that particular environment. Conclusion: These data suggest that a patient's expressed readiness for rehabilitative change is the best predictor of making change. Also, that satisfaction and dissatisfaction is not limited to a single domain but seems to be generalized across the four environments.
~!c>
SUCCESSFUL VOCATIONAL FUNCTIONING IN SCHIZOPHRENIA James M. Gold, Nancy L. Bryant, Katalin Vladar, Robert W . Buchanan Maryland Psychiatric Research Center. Department of Psychiatry, University of Maryland. Baltimore M aryland 21228. USA
Follow up studies in schizophrenia have documented successful vocational functioning in 10-30% of patients . However, the neurobiological characteristics associated with vocational outcome remain poorly understood. This exploratory study contrasts the neuropsychological and brain structural characteristics of patients who demonstrate good vocational functioning (GVF), patients with poor vocational functioning (PVF), and healthy controls. The Level of Functioning Scale was used to assess vocational outcome. Comparison of the two patient groups revealed that GVF patients had superior neuropsychological performance, relative to the PVF group, across multiple measures, with moderate to large effect sizes (0.4-1.0). In contrast, the two patient groups did not differ on the degraded stimulus CPT, a putative vulnerability marker, with both groups demonstrating deficits relative to healthy controls. MRI data were examined in 8 GVF, 8 PVF, and 8 controls matched on age, gender, race (all right handed). Both GVF patients and healthy controls demonstrated asymmetries in temporal and frontal lobe volumes (R>L) which were lacking in PVF patients. The results suggests that poor vocational outcome in schizophrenia may be associated with neurodevelopmental factors that impact cortical specialization-lateralization,
whereas GVF patients appear to have a more 'focal' illness, both cognitively and in terms of brain structure.
b31 DISSEMINATING TREATMENT RECOMMENDATIONS FROM THE SCHIZOPHRENIA P.O.R.T. Howard H. Goldman Department ofPsychiatry, University ofMaryland School of Medicine; Baltimore. MD21201. USA
Elizabeth A. McGlynn RAND Corporation. Santa Monica, CA 90406. USA
Here we focus on the dissemination of the Schizophrenia PORT treatment recommendations. The five communities involved in the Schizophrenia PORT data collection were also selected to participate in the plan to disseminate the recommendations, permitting the PORT to track the impact of the effort. In March and April, 1996, providers, patients , and their families in each of the communities were exposed to a one-day continuing education program on a selection of treatment recommendations focusing on psychopharmacology, family interventions, assertive community treatment and inpatient care. In addition, pairs of the communities were involved in supplementary dissemination strategies: for example, 'academic detailing' was used to amplify the dissemination of the psychopharmacologic recommendations during the autumn of 1996 and training in specific techniques of family supportive interventions were begun in June, 1996. The feasibility of these strategies will be assessed, and their impact will be evaluated, examining patterns of pract ice abstracted from clinical records.
.
~:n
QUALITY OF LIFE IN SCHIZOPHRENIA: AFFILIATIVE AND INSTRUMENTAL DOMAINS Marianne S. Goodman, James W. Hull, Kenneth G. Terkelsen, Thomas E. Smith Department ofPsychiatry, Cornell University Medical College. White Plains. NY 10605, USA
This study of 67 chronically mentally ill outpatients with psychotic disorders examined subjective quality of life scores from Lehman's Quality of Life (QOL) interview. Factor an~Y· ses identified 'Affiliative' and 'Instrumental' constructs which accounted for 67% of the variance in subjective satisfac~on ratings . The results suggest that the global satisfacti~n ratulg may be derived from instrumental ~ncc:rns an~ IS not a summation of individual domain subjective ratings" ,Th~ findings further clarify the concept of life satisfaction 10 this population of severely mentally ill individ?als. and suggest modifications in bow quality of life information IS evaluated.