Course Patterns of Psychosocial Functioning in Schizophrenia Patients Attending a Vocational Rehabilitation Program

Abstract

Although considerable research has been undertaken on psychosocial treatment and rehabilitation of patients with chronic schizophrenia, few studies have examined individual courses by means of repeated and frequent observation. A more dynamic view of rehabilitation might disclose patterns of response useful for both understanding and treating symptoms and disabilities associated with chronic schizophrenia. In an exploratory study, time series of 35 schizophrenia outpatients participating in a vocational rehabilitation program were examined by a relatively original quantitative approach to the identification of dynamical patterns. By using time series regression on weekly behavioral ratings, dynamical properties of mean, trend, and variability were calculated. Cluster analysis revealed five subgroups of courses: (1) stable at a high level, (2) fluctuating at a middle level, (3) at a middle level, tending toward a slight descent, (4) showing a steep descent, and (5) unstable at a low level of functioning. The subgroups varied at intake in psychopathology; in cognitive dysfunction; and in measures of self-concept, locus of control, and coping. At program end, pronounced differences were found among the subgroups in vocational reintegration. These different dynamical patterns can be understood as typical pathways linking patient characteristics to rehabilitation outcome. A broader use of dynamical designs could substantially clarify the variety of reactions of patients to psychosocial interventions.

Attention Shaping: a Reward-Based Learning Method to Enhance Skills Training Outcomes in Schizophrenia

“…These parameters are ideal to characterize variability in dynamic systems over time 57 and have been useful in analyzing treatment response to psychiatric rehabilitation interventions. 58 In addition to examining the variable of total minutes of attentiveness in each group, we examined the average duration of discrete periods when attentiveness was demonstrated. Effects of medication on attentiveness were examined by calculating the correlation between daily attentiveness ratings and daily CPZ equivalent dose for each subject.…”

Evaluating outcomes of rehabilitation for severe mental illness.

“…Time series analysis can be used to study a single course by means of repeated and frequent observations. Such analyses can help describe patterns of symptoms and functioning over the course of treatment and elucidate pathways from patient characteristics to rehabilitation outcomes (Kupper & Hoffmann, 2000). For example, using a time series approach, Kupper and Tschacher (2002) tracked individual symptom trajectories among inpatients with schizophrenia spectrum disorders during an average treatment period of 104 days.…”

Heterogeneity in Behavioral Treatment Response in Severe Mental Illness

“…For example, a high external LOC (i.e., the attribution that life events result from external factors as opposed to one's behavior) was found to predict poor rehabilitation outcomes Kupper and Hoffmann, 2000). Collectively these findings indicate that individual patient characteristics contribute to psychosocial treatment response.…”

“…Poorer neurocognitive functioning was associated with lower levels of psychosocial functioning at the beginning of treatment and slower treatment response Kupper and Hoffmann, 2000;; see also Smith et al, 2002). Social cognitive functioning (i.e., perception and interpretation of social information and how this information informs attributions about the self) showed a similar pattern of associations Kupper and Hoffmann, 2000).…”

“…In addition to heterogeneous outcomes, there has been a recent focus on the heterogeneity in the longitudinal process of treatment response . Investigations using multivariate time series analysis and hierarchical linear modeling (HLM) have quantified this longitudinal heterogeneity in psychosocial treatment response in community rehabilitation settings Kupper and Hoffmann, 2000). Research specific to inpatient rehabilitation programs with a CM component has also identified longitudinal heterogeneity in psychosocial treatment response Silverstein et al, 2006).…”