This study will determine the effectiveness of combining antipsychotic medication with Individual Placement and Support (IPS) and group training with the Workplace Fundamentals Module or Brokered Vocational Rehabilitation in facilitating the search for appropriate work or schooling and maintaining work or school activities in people with recent-onset schizophrenia.
The purpose of this protocol is to test, in recent-onset schizophrenia, the efficacy of a rehabilitative intervention that is designed to enhance the search for appropriate work or schooling and to increase ability to maintain work or school activities more successfully. Predictors of work outcome are being assessed in the context of this work rehabilitation and treatment with the second-generation antipsychotic medication, risperidone. The Developmental Processes in Schizophrenic Disorders project involves an ongoing series of longitudinal follow-through studies of individuals with a recent onset of schizophrenia. The current protocol focuses particularly on processes affecting work outcome in this initial period after onset of schizophrenia, drawing on findings that link cognitive deficits in schizophrenia to functional outcome. The protocol is determining the effects on work outcome of a rehabilitative intervention designed to enhance search for appropriate work or schooling and to increase ability to maintain work or school activities more successfully. All entering patients are placed on a common antipsychotic medication, oral risperidone, and are provided clinical treatment by a psychiatrist and a case manager. Participating patients are randomly assigned to a combination of Individual Placement and Support (IPS) and group training with the Workplace Fundamentals Module or to a Brokered Vocational Rehabilitation Model. The protocol is examining the predictors of level of work functioning attained in the context of the work-focused intervention and maintenance on risperidone. Potential neurocognitive and environmental predictors of work and social functioning and clinical course are being examined. Aspects of early perceptual processing, allocation of attention, working memory, secondary verbal memory, and conceptual flexibility that are implicated as influences on functional outcome are assessed, as are potential stresses and supportive influences in the environment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
87
Supported education/employment
Group skills training on job/school topics
Vocational rehabilitation through traditional separate state-funded agency
UCLA Neuropsychiatric Institute
Los Angeles, California, United States
Return to regular work or school during 18 month trial (SAS Work Section)
Time frame: Every 3 months
Maintenance of work/school attendance over 18 months (SAS)
Time frame: Every 3 months
Quality of work functioning on Work Behavior Inventory
Time frame: Baseline, 6 months, 18 months
Cognitive performance on test battery
Time frame: Baseline, 6 months, 18 months
Exacerbation or relapse of psychotic symptoms (BPRS)
Time frame: Every 2 weeks
Retention in treatment
Time frame: Every 3 months
Awareness of illness (SUMD-R)
Time frame: Entry, 6 months, 18 months
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Risperidone, starting target dosage was 6 mg, adjusted to level judged optimal by treating psychiatrist
Group social skills training that did not focus primarily on work situations