RESUMEN

BACKGROUND AND OBJECTIVE: In individuals experiencing homelessness, determinants of functional capacity (i.e. the ability to perform activities of daily living) are poorly understood. Identifying potentially modifiable correlates of functional capacity, such as cognitive abilities, may inform treatment targets to address independence and housing stability. This study aimed to identify the strongest neuropsychological predictors of variance in functional performance in 100 adults living in a homeless shelter. METHODS: Participants completed a brief cognitive screening test, from which four composite scores were derived, as well as tests of processing speed, fluid reasoning, premorbid intellectual function, and performance-based functional capacity. We conducted a hierarchical linear regression to predict variance in functional capacity. RESULTS: Beyond the impact of education and premorbid intellectual function, better memory and fluid reasoning predicted better functional performance. CONCLUSIONS: Although our cross-sectional design does not permit causal inference, it is possible that interventions targeting memory and fluid reasoning may improve functional ability in individuals experiencing homelessness.

Asunto(s)

Actividades Cotidianas , Personas con Mala Vivienda , Humanos , Adulto , Actividades Cotidianas/psicología , Pruebas Neuropsicológicas , Estudios Transversales , Cognición

RESUMEN

OBJECTIVE: This study examined rates of objective cognitive and functional impairments and associations between cognitive performance and performance-based functional capacity in a well-characterized sample of adults experiencing homelessness. METHODS: One hundred participants completed a brief neuropsychological and functional capacity assessment and self-report questionnaires. Cognitive impairment rates were determined by comparing mean scores with published normative data, as well as by examining frequency of scores >1 SD below the mean. Pearson correlations were used to examine associations between cognitive and functional capacities. RESULTS: Overall, 65% of the study participants had scores in the cognitively impaired range on a brief cognitive screening test, 30% had impaired processing speed, and 11% met cognitive criteria for intellectual disability. Furthermore, 48% of the sample met functional impairment criteria, and poorer cognitive performance was strongly associated with poorer performance-based functional capacity (p<0.001). CONCLUSIONS: Cognitive and functional impairments are common among sheltered adults experiencing homelessness, underscoring the need for routine objective cognitive screening and rehabilitation services.

Asunto(s)

Trastornos del Conocimiento , Disfunción Cognitiva , Personas con Mala Vivienda , Adulto , Cognición , Trastornos del Conocimiento/epidemiología , Disfunción Cognitiva/epidemiología , Humanos , Pruebas Neuropsicológicas

RESUMEN

Adults who are homeless experience high rates of health conditions and psychological distress, including low IQ and functional status. Resources are available to help these individuals, but provision of support is often contingent upon the identification of a known disability. In this context, we examined case managers' (CMs') subjective estimates of IQ and functional status in 77 adult residents of an urban homeless shelter. Participants completed objective measures of IQ and functional capacity. CMs overestimated IQs of lower IQ (IQ < 90) participants, correctly estimated IQs of average IQ (IQ = 90-110) participants, and underestimated IQs of higher IQ (IQ > 110) participants. CMs correctly identified 2 out of 8 participants meeting criteria for intellectual disability and 4 out of 16 participants with impaired functional status. These findings suggest that subjective evaluations of IQ and functional status are prone to a central tendency bias, leading CMs to overlook clients who are in need of assistance. Consequently, the objective measurement of IQ and functional status in homeless shelters is highly recommended. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Asunto(s)

Gestores de Casos/organización & administración , Estado Funcional , Personas con Mala Vivienda/psicología , Discapacidad Intelectual/diagnóstico , Inteligencia , Adulto , California , Femenino , Humanos , Pruebas de Inteligencia , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud

RESUMEN

AIMS: To examine the prevalence of and factors associated with unmet need for mental health and substance use treatment in older homeless adults. METHODS: Among 350 homeless adults aged ≥50, we examined prevalence of mental health and substance use problems and treatment. Using logistic regression, we examined factors associated with unmet treatment need. RESULTS: Among those with a mental health problem, being aged ≥65 was associated with an increased odds, while having a regular healthcare provider and case manager were associated with a decreased odds of having unmet need for mental health treatment. A first homelessness episode at age ≥50 was associated with increased, while spending time in jail/prison or having a case manager was associated with decreased odds of unmet needs for substance use treatment. CONCLUSION: Older homeless adults have a high prevalence of unmet behavioral health treatment need. There is a need for targeted services for this population.

Asunto(s)

Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Personas con Mala Vivienda/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Anciano , Anciano de 80 o más Años , Envejecimiento/psicología , California/epidemiología , Humanos , Acontecimientos que Cambian la Vida , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia

RESUMEN

OBJECTIVE: Among people with severe mental illnesses, neuropsychological abilities may contribute to vocational outcomes, such as job attainment, job tenure, and wages earned. The current study aimed to determine the strongest neuropsychological and other modifiable predictors of work outcomes in 153 people with severe mental illness (schizophrenia, 38%; bipolar disorder, 24%; and major depression, 38%) who participated in a 2-year supported employment study. METHODS: Assessments of neuropsychological performance, functional capacity, social skills, and psychiatric symptom severity were administered at baseline; work outcomes (job attainment, weeks worked, and wages earned) were collected weekly for 2 years. RESULTS: Independent of education, diagnosis, and estimated intellectual functioning, more recent work history and less severe negative symptoms significantly predicted job attainment during the 2-year study. Among the 47% who obtained jobs, better global neuropsychological performance (i.e., lower global deficit score) was a significant predictor of greater weeks worked. Both global neuropsychological performance and more recent work history predicted higher wages earned. CONCLUSIONS: Modifiable predictors of supported employment outcomes included cognitive functioning and negative symptom severity; thus, interventions to improve these factors may improve work outcomes and decrease the loss of productivity associated with severe mental illness.

Asunto(s)

Trastorno Bipolar/rehabilitación , Disfunción Cognitiva/rehabilitación , Trastorno Depresivo Mayor/rehabilitación , Empleos Subvencionados/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Esquizofrenia/rehabilitación , Adulto , Trastorno Bipolar/complicaciones , Disfunción Cognitiva/etiología , Trastorno Depresivo Mayor/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Esquizofrenia/complicaciones

RESUMEN

Veterans seeking care in VA medical facilities have high rates of chronic pain, which often co-occur with mental health and substance use disorders, including prescription opioid misuse. The overall goal of the Optimizing Pain Treatment Interventions (OPTI) study was to pilot a 12-week Collaborative Care intervention to improve opioid safety, chronic pain disability, and use of non-pharmacological pain management strategies in veterans in VA primary care. Between November 2014 and January 2017, 100 veteran patients with chronic pain and high-risk prescription opioid use (e.g., high-dose therapy, early refills, etc.) were enrolled and completed an initial one-hour study visit with a primary care provider (PCP) within 4 weeks of enrollment. Study PCPs were guided by a web-based opioid management decision support program and templated notes in the VA electronic medical record. After assessment and education, study PCPs used Shared Decision-Making to formulate a Pain Care Plan aligned with a participant's personal values and goals. After the initial visit, patients randomized to Collaborative Care received one Motivational Interviewing (MI) session with a Care Manager followed by 3 Care Manager-delivered brief telephone MI sessions at 6, 8, and 12 weeks to reinforce Pain Care Plans; patients randomized to an Attention Control condition met with a Care Manager briefly, followed by 3 brief scripted telephone psychoeducation sessions at 6, 8, and 12 weeks. Masked evaluators assessed outcomes at baseline, end of intervention (12 weeks), and after eight weeks of no contact (20 weeks). We present study rationale, detailed methods, preliminary results and lessons learned.

Asunto(s)

Dolor Crónico/terapia , Manejo del Dolor/métodos , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Veteranos , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Conducta Cooperativa , Evaluación de la Discapacidad , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Entrevista Motivacional/métodos , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/prevención & control , Planificación de Atención al Paciente , Participación del Paciente/métodos , Guías de Práctica Clínica como Asunto , Proyectos de Investigación , Factores de Riesgo , Autoeficacia , Método Simple Ciego , Estados Unidos , United States Department of Veterans Affairs , Adulto Joven

RESUMEN

OBJECTIVE: Prospective memory (the ability to remember to do things) has clear implications for everyday functioning, including employment, in people with severe mental illnesses (SMI). This study aimed to evaluate prospective memory performance and its relationship to real-world functional variables in an employment-seeking sample of people with SMI (Clinical Trial registration number NCT00895258). METHOD: 153 individuals with DSM-IV diagnosis of depression (n = 58), bipolar disorder (n = 37), or schizophrenia (n = 58) who were receiving outpatient psychiatric care at a university clinic enrolled in a trial of supported employment and completed a baseline assessment. Prospective memory was measured with the Memory for Intentions Test (MIST); real-world functional status included work history variables, clinical history variables, baseline functional capacity (UCSD Performance-based Skills Assessment-Brief), and work outcomes (weeks worked and wages earned during two years of supported employment). RESULTS: Participants with schizophrenia performed worse on the MIST than did those with affective disorders. Independent of diagnosis, education, and estimated intellectual functioning, prospective memory significantly predicted variance in measures of disability and illness burden (disability benefits, hospitalization history, current functional capacity), and work outcomes over two years of supported employment (weeks worked). CONCLUSIONS: Worse prospective memory appears to be associated with greater illness burden and functional disability in SMI. Mental health clinicians and employment specialists may counsel clients to use compensatory prospective memory strategies to improve work performance and decrease functional disability associated with SMI.

Asunto(s)

Personas con Discapacidad/estadística & datos numéricos , Memoria Episódica , Salud Mental/tendencias , Pruebas Neuropsicológicas/normas , Reinserción al Trabajo/tendencias , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

Treatments for cognitive and functional impairments associated with severe mental illnesses are urgently needed. We tested a 12-week, manualized, Compensatory Cognitive Training (CCT) intervention targeting prospective memory, attention, learning/memory, and executive functioning in the context of supported employment for people with severe mental illnesses who were seeking work. 153 unemployed, work-seeking outpatients with schizophrenia/schizoaffective disorder (n=58), bipolar disorder (n=37), or major depression (n=58) were randomized to receive supported employment plus CCT or enhanced supported employment, a robust control group. Assessments of neuropsychological performance, functional capacity, psychiatric symptom severity, and self-reported functioning and quality of life were administered at baseline and multiple follow-up assessments over two years; work outcomes were collected for two years. Forty-seven percent of the participants obtained competitive work, but there were no differences in work attainment, weeks worked, or wages earned between the CCT and the enhanced supported employment group. ANCOVAs assessing immediate post-treatment effects demonstrated significant, medium to large, CCT-associated improvements on measures of working memory (p=0.038), depressive symptom severity (p=0.023), and quality of life (p=0.003). Longer-term results revealed no statistically significant CCT-associated improvements, but a trend (p=0.058) toward a small to medium CCT-associated improvement in learning. Diagnostic group (schizophrenia-spectrum vs. mood disorder) did not affect outcomes. We conclude that CCT has the potential to improve cognitive performance, psychiatric symptom severity, and quality of life in people with severe mental illnesses. Receiving CCT did not result in better work outcomes, suggesting that supported employment can result in competitive work regardless of cognitive status.

Asunto(s)

Trastorno Bipolar/rehabilitación , Disfunción Cognitiva/rehabilitación , Remediación Cognitiva/métodos , Trastorno Depresivo Mayor/rehabilitación , Empleos Subvencionados , Rehabilitación Psiquiátrica/métodos , Trastornos Psicóticos/rehabilitación , Esquizofrenia/rehabilitación , Adulto , Trastorno Bipolar/complicaciones , Disfunción Cognitiva/etiología , Trastorno Depresivo Mayor/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Trastornos Psicóticos/complicaciones , Esquizofrenia/complicaciones

RESUMEN

Neuropsychological abilities may underlie successful performance of everyday functioning and social skills. We aimed to determine the strongest neuropsychological predictors of performance-based functional capacity and social skills performance across the spectrum of severe mental illness (SMI). Unemployed outpatients with SMI (schizophrenia, bipolar disorder, or major depression; n = 151) were administered neuropsychological (expanded MATRICS Consensus Cognitive Battery), functional capacity (UCSD Performance-Based Skills Assessment-Brief; UPSA-B), and social skills (Social Skills Performance Assessment; SSPA) assessments. Bivariate correlations between neuropsychological performance and UPSA-B and SSPA total scores showed that most neuropsychological tests were significantly associated with each performance-based measure. Forward entry stepwise regression analyses were conducted entering education, diagnosis, symptom severity, and neuropsychological performance as predictors of functional capacity and social skills. Diagnosis, working memory, sustained attention, and category and letter fluency emerged as significant predictors of functional capacity, in a model that explained 43% of the variance. Negative symptoms, sustained attention, and letter fluency were significant predictors of social skill performance, in a model explaining 35% of the variance. Functional capacity is positively associated with neuropsychological functioning, but diagnosis remains strongly influential, with mood disorder participants outperforming those with psychosis. Social skill performance appears to be positively associated with sustained attention and verbal fluency regardless of diagnosis; however, negative symptom severity strongly predicts social skills performance. Improving neuropsychological functioning may improve psychosocial functioning in people with SMI.

Asunto(s)

Trastornos del Conocimiento/etiología , Trastornos Mentales/complicaciones , Trastornos Mentales/psicología , Pruebas Neuropsicológicas , Habilidades Sociales , Adulto , Trastornos del Conocimiento/diagnóstico , Femenino , Humanos , Masculino , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Análisis de Regresión

Asunto(s)

Hospitalización , Readmisión del Paciente , Medicina Basada en la Evidencia , Humanos , Maryland , Estudios Prospectivos

RESUMEN

The UCSD Performance-Based Skills Assessment (UPSA) is a performance-based measure of functional capacity. The brief, two-domain (finance and communication ability) version of the assessment (UPSA-B) is now widely used in both clinical research and treatment trials. To date, research has not examined possible demographic-UPSA-B relationships within a non-psychiatric population. We aimed to produce and describe preliminary normative scores for the UPSA-B over a full range of ages and educational attainment. The finance and communication subscales of the UPSA were administered to 190 healthy participants in the context of three separate studies. These data were combined to examine the effects of age, sex, and educational attainment on the UPSA-B domain and total scores. Fractional polynomial regression was used to compute demographically-corrected T-scores for the UPSA-B total score, and percentile rank conversion was used for the two subscales. Age and education both had significant non-linear effects on the UPSA-B total score. The finance subscale was significantly related to both gender and years of education, whereas the communication subscale was not significantly related to any of the demographic characteristics. Demographically corrected T-scores and percentile ranks for UPSA-B scores are now available for use in clinical research.

Asunto(s)

Actividades Cotidianas/psicología , Comunicación , Habilidades Sociales , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Adulto Joven

RESUMEN

The catechol-O-methyltransferase (COMT) ValMet polymorphism is associated with cognitive functioning in schizophrenia and may predict cognitive training outcomes. This study aimed to explore the contribution of COMT genotype in predicting improvement following Compensatory Cognitive Training (CCT). We conducted mixed factorial analysis of variance to examine COMT genotype as a predictor of response to CCT (i.e. improved cognitive performance) in 41 participants with schizophrenia-spectrum disorders. We also explored the effect of CCT treatment and COMT genotype on psychiatric symptom severity, functional capacity, and subjective quality of life. Met carrier status did not predict CCT treatment outcomes. COMT genotype may exert only modest effects on cognitive training response. Further research with larger samples is needed to establish genetic predictors of response to cognitive training.

Asunto(s)

Catecol O-Metiltransferasa/genética , Trastornos del Conocimiento/terapia , Cognición/fisiología , Terapia Cognitivo-Conductual/métodos , Pacientes Ambulatorios/psicología , Esquizofrenia/genética , Esquizofrenia/terapia , Adulto , Catecol O-Metiltransferasa/metabolismo , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Esquizofrenia/sangre , Esquizofrenia/enzimología

RESUMEN

Homeless people experience elevated rates of risk factors for cognitive impairment. We reviewed available peer-reviewed studies reporting data from objective measures of cognition in samples identified as homeless. Pooled sample-weighted estimates of global cognitive screening measures, full-scale intelligence quotient (IQ), and premorbid IQ were calculated, in addition to pooled sample characteristics, to understand the representativeness of available studies. A total of 24 unique studies were identified, with 2969 subjects. The pooled estimate for the frequency of cognitive impairment was 25%, and the mean full-scale IQ score was 85, 1 standard deviation below the mean of the normal population. Cognitive impairment was found to be common among homeless adults and may be a transdiagnostic problem that impedes rehabilitative efforts in this population. Comparatively little data are available about cognition in homeless women and unsheltered persons.

Asunto(s)

Trastornos del Conocimiento/epidemiología , Personas con Mala Vivienda/estadística & datos numéricos , Inteligencia/fisiología , Adulto , Humanos

RESUMEN

Cognitive and functional impairments are core features of schizophrenia. This study examined the catechol-O-methyltransferase (COMT) genotype and its relationship to cognition and functional capacity in 188 individuals with schizophrenia or schizoaffective disorder. We found that in a dose-response fashion, individuals with more Met alleles performed significantly better on tests of learning/memory and abstraction. The effects of COMT genotype on cognition were modest, explaining about 3% of the variance in learning/memory and abstraction. Larger studies will be needed to examine the relationships between COMT and other genes and cognitive performance and everyday functioning.

Asunto(s)

Catecol O-Metiltransferasa/genética , Cognición , Trastornos Psicóticos/genética , Trastornos Psicóticos/psicología , Esquizofrenia/genética , Psicología del Esquizofrénico , Femenino , Genotipo , Humanos , Aprendizaje , Masculino , Memoria , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Factores Sexuales , Pensamiento

RESUMEN

BACKGROUND: The MATRICS Consensus Cognitive Battery (MCCB) and proposed co-primary measures are gaining momentum as outcome measures in clinical trials, highlighting the need to evaluate their psychometric properties. The MCCB composite score has been proposed to be the optimal primary outcome measure, though its validity is unknown. This study aimed to evaluate the factor structure of the MCCB in a schizophrenia sample and determine whether its cognitive domains are separable. METHODS: 183 outpatients with schizophrenia or schizoaffective disorder completed a comprehensive test battery. Confirmatory factor analysis was used to test the factor structure of the MCCB; hierarchical regression then examined the relative contribution of individual cognitive variables to predict the MCCB factor scores. Finally, the relationships between the resulting factors and two performance-based measures of functional capacity were explored. RESULTS: A three-factor MCCB model representing processing speed, attention/working memory, and learning fits the data well and was an improvement over a unifactorial model. Symbol coding, spatial span, and visual learning were the most robust predictors for each of the three factors; symbol coding proved to be the best single predictor of overall cognitive performance. The three factors were also significantly related to a performance-based measure of everyday functioning but not a performance-based measure of social skills. CONCLUSIONS: These analyses suggest that the six MCCB "domains" as constructed can be collapsed into fewer domains composed of multiple item scores; they also support the notion that impaired processing speed is a fundamental cognitive deficit in schizophrenia and that MCCB performance is related to functional capacity. Cognition and functional capacity measures require more research to determine if they differ.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Pruebas Neuropsicológicas , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Actividades Cotidianas , Adulto , Atención , Análisis Factorial , Femenino , Humanos , Masculino , Memoria a Corto Plazo , Persona de Mediana Edad , Pacientes Ambulatorios , Escalas de Valoración Psiquiátrica , Psicometría , Reproducibilidad de los Resultados

RESUMEN

Although neurocognition is commonly described in terms of different functional domains, some factor analytic studies have suggested a simpler dimensional structure for neuropsychological (NP) tests in patients with schizophrenia. Standardized tasks of everyday functioning, or tests of "functional capacity" (FC), are viewed differently from traditional NP tests, and are hence used as a co-primary measure in treatment studies. However, FC and NP tests have been found to be highly correlated. In fact, a recent study of ours suggested that performances on these different types of tasks constituted a single latent trait in a cross-sectional analysis. The current study examined the longitudinal factor structure of a combined set of NP and FC tests. Patients with schizophrenia (n = 195) were examined at two assessment occasions separated by periods ranging from 6 weeks to 6 months. Participants were assessed with the MATRICS Consensus Cognitive Battery (MCCB) and two performance-based assessments of FC. A single latent trait was extracted using full information maximum likelihood procedures, and its temporal stability was examined in terms of: stability of the latent trait scores, the inter-correlations of the three indicators of the latent trait, and the stability of loadings for the FC and NP items underlying the latent trait at the two measurement occasions. All indices of temporal stability were confirmed, with stability not related to follow-up duration. Variation in clinical symptoms and treatments across the measurement occasions was negligible. These findings raise the question of whether cognitive abilities measured by NP tests and FC instruments are tapping a single ability construct, which might have shared causal influences as well.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Femenino , Humanos , Funciones de Verosimilitud , Estudios Longitudinales , Masculino , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica

RESUMEN

OBJECTIVE: Social cognition is strongly associated with functional outcome in schizophrenia, making it an important target for treatment. Our goal was to examine the average magnitude of differences between schizophrenia patients (SCs) and normal comparison (NCs) patients across multiple domains of social cognition recognized by the recent NIMH consensus statement: theory of mind (ToM), social perception, social knowledge, attributional bias, emotion perception, and emotion processing. METHOD: We conducted a meta-analysis of peer-reviewed studies of social cognition in schizophrenia, published between 1980 and November, 2011. RESULTS: 112 studies reporting results from 3908 SCs and 3570 NCs met our inclusion criteria. SCs performed worse than NCs across all domains, with large effects for social perception (g = 1.04), ToM (g = 0.96), emotion perception (g = 0.89), and emotion processing (g = 0.88). Regression analyses showed that statistically significant heterogeneity in effects within domains was not explained by age, education, or gender. Greater deficits in social and emotion perception were associated with inpatient status, and greater deficits in emotion processing were associated with longer illness duration. CONCLUSIONS: Despite the limitations of existing studies, including lack of standardization or psychometric validation of measures, the evidence for deficits across multiple social cognitive domains in schizophrenia is clear. Future research should examine the role of neurobiological and psychosocial factors in models linking various aspects of deficit in schizophrenia, including social cognition, in order to identify targets for intervention.

Asunto(s)

Trastornos del Conocimiento/fisiopatología , Emociones/fisiología , Esquizofrenia/fisiopatología , Percepción Social , Teoría de la Mente/fisiología , Trastornos del Conocimiento/etiología , Humanos , Esquizofrenia/complicaciones

RESUMEN

OBJECTIVE: Treatments for the cognitive impairments of schizophrenia are urgently needed. We developed and tested a 12-week, group-based, manualized, compensatory cognitive training intervention targeting prospective memory, attention, learning/memory, and executive functioning. The intervention focused on compensatory strategies, such as calendar use, self-talk, note taking, and a 6-step problem-solving method, and did not require computers. METHOD: In a randomized controlled trial, 69 outpatients with DSM-IV primary psychotic disorders were assigned to receive standard pharmacotherapy alone or compensatory cognitive training + standard pharmacotherapy for 12 weeks. Assessments of neuropsychological performance and functional capacity (primary outcomes) and psychiatric symptom severity, quality of life, social skills performance, cognitive insight, and self-reported everyday functioning (secondary outcomes) were administered at baseline, posttreatment, and 3-month follow-up. Data were collected between September 2003 and August 2009. RESULTS: Hierarchical linear modeling analyses demonstrated significant compensatory cognitive training-associated effects on attention at follow-up (P = .049), verbal memory at posttreatment and follow-up (P values ≤ .039), and functional capacity (University of California, San Diego Performance-based Skills Assessment) at follow-up (P = .004). The compensatory cognitive training group also differentially improved in negative symptom severity at posttreatment and follow-up (P values ≤ .025) and subjective quality of life at follow-up (P = .002). CONCLUSIONS: Compensatory cognitive training, a low-tech, brief intervention, has the potential to improve not only cognitive performance but also functional skills, negative symptoms, and self-rated quality of life in people with psychosis. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01521026.

Asunto(s)

Actividades Cotidianas , Terapia Cognitivo-Conductual/métodos , Psicoterapia Breve/métodos , Psicoterapia de Grupo/métodos , Trastornos Psicóticos/terapia , Esquizofrenia/terapia , Adulto , Atención , Función Ejecutiva , Femenino , Humanos , Aprendizaje , Modelos Lineales , Masculino , Manuales como Asunto , Memoria , Proyectos Piloto , Solución de Problemas , Estados Unidos

RESUMEN

Despite multiple lines of evidence suggesting that people with schizophrenia have substantial problems in self-reporting everyday functioning and cognitive performance, self-report methods are still widely used to assess functioning. This study attempted to identify predictors of accuracy in self report, both in terms of accurate self-assessment and over-estimation of current functioning. As part of the larger Validating Assessments of Everyday Real-World Outcomes (VALERO) study, 195 patients with schizophrenia were asked to self report their everyday functioning with the Specific Levels of Functioning (SLOF) scale, which includes subscales assessing social functioning, everyday activities, and vocational functioning. They were also assessed with measures of neuropsychological (NP) performance and functional capacity (FC), and were assessed for psychiatric symptomatology. In addition, a friend, relative or clinician informant was interviewed with the SLOF, and an interviewer with access to all information provided by the patient and informant (exclusive of performance-based data) generated "best estimate" ratings of actual, everyday functioning. Patients significantly (p<.001) overestimated their vocational functioning and everyday activities compared to the interviewer judgments. Lower levels of NP and FC performance and everyday functioning on the part of patients were consistently associated with overestimation of their functioning. Patient self-reports were not correlated with any performance-based measures, while interviewer judgments were significantly correlated with patients' performance on NP and FC measures (p<.005). In regression analyses, adjusting for interviewer ratings of functioning, several predictors of the discrepancy between self and interviewer judgments emerged. Higher levels of depressive symptoms were associated with less overestimation in self-reports (p<.001). Delusions, suspiciousness, grandiosity and poor rapport were all significantly (p<.001) associated with over-estimation of functioning compared to interviewer judgments. Poorer NP and FC performance were also associated with over-estimation of everyday functioning, but these results were not statistically significant in multivariate regression models. Consistent with previous studies in schizophrenia, other neuropsychiatric conditions and non-clinical populations, higher levels of depression were associated with increased accuracy in self-assessment. Similarly, lower scores on performance-based measures and judgments of everyday functioning also predicted over-estimation of functioning. Thus, we identified bi-directional predictors of mis-estimation of everyday functioning, even when poor baseline scores were considered. These data suggest that it may be possible to screen patients for their ability to self-report their functioning, but that performance-based measures of functioning provide a less biased assessment.

Asunto(s)

Actividades Cotidianas , Esquizofrenia/diagnóstico , Esquizofrenia/fisiopatología , Psicología del Esquizofrénico , Autoevaluación (Psicología) , Adulto , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Femenino , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Escalas de Valoración Psiquiátrica

RESUMEN

OBJECTIVE: Supported employment is the evidence-based treatment of choice for assisting individuals with severe mental illness to achieve competitive employment, but few supported employment programs specifically target older clients with psychiatric illness. The purpose of this study was to evaluate the efficacy of supported employment for middle-aged or older people with schizophrenia. METHOD: Participants included 58 outpatients with schizophrenia or schizoaffective disorder aged 45 or older who were recruited from a community mental health clinic. Participants were randomly assigned to receive Individual Placement and Support (IPS; the manualized version of supported employment) or conventional vocational rehabilitation (CVR) for one year, and completed assessments at baseline, six months, and twelve months. RESULTS: IPS was superior to CVR on nearly all work outcome measures, including attainment of competitive employment, weeks worked, and wages earned. Fifty-seven percent of IPS participants worked competitively, compared with 29% of CVR participants; 70% of IPS participants obtained any paid work, compared with 36% of CVR participants. Within the IPS group, better baseline functional capacity (as measured by the UCSD Performance Based Skills Assessment) and more recent employment were modestly associated with better work outcomes. CONCLUSIONS: Middle-aged and older adults with schizophrenia are good candidates for supported employment services.

Asunto(s)

Empleos Subvencionados , Rehabilitación Vocacional/métodos , Esquizofrenia/rehabilitación , Psicología del Esquizofrénico , Anciano , Envejecimiento/psicología , Área Bajo la Curva , Empleo , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Trastornos Psicóticos/psicología , Trastornos Psicóticos/rehabilitación , Índice de Severidad de la Enfermedad