From hospital admission to independent living: Is prediction possible?

Lipskaya-Velikovsky, Lena; Kotler, Moshe; Easterbrook, Adam; Jarus, Tal

doi:10.1016/j.psychres.2015.01.027

Cited by 5 publications

(2 citation statements)

References 53 publications

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“…In addition, by controlling for other covariates in regression models, our study revealed that patients who had better IADL ability showed better work performance in the future. This finding is in accordance with other studies that found a significant relationship between IADL level and functional outcomes in patients with schizophrenia [23,47,48]. Furthermore, we found an important finding that IADL scores were significantly with both employment outcomes for patients without remission.…”

Section: Discussionsupporting

confidence: 93%

Symptomatic remission in schizophrenia affects employment outcomes; Instrumental activity of daily living is a determinant for non-remitted patients

Wang¹,

Wang²,

Chang³

et al. 2020

Preprint

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Background: Remission criteria were proposed by Andreasen for classifying patients with schizophrenia according to the severity of psychopathology. Up to the present time, there have been no cohort studies exploring the association between remission status and employment outcomes in patients with schizophrenia. The study aimed to explore whether symptomatic remission is significantly associated with employment outcomes in a two-year longitudinal study, and to investigate factors associated with favorable employment outcomes for patients without symptomatic remission at baseline.Methods: All of 525 stable patients with schizophrenia in the therapeutic community of a public mental hospital between 2013 and 2015 in Taiwan were recruited. Employment outcomes, defined as the cumulative on-the-job duration (months/per year) and income (new Taiwan dollars, NT$/per year), were investigated at the end of 1- and 2-year follow-up after enrollment. For repeated measurements, linear mixed models were constructed to examine the association between symptomatic remission and employment outcomes after controlling for potential confounding variables including age, sex, education, type and daily dose of antipsychotics, cognitive function, activities of daily living (ADL), instrumental activities of daily living (IADL), and initial employment type.Results: The average age was 51.8 years, and 65.3% were males. Among them, 124 patients (23.6%, 124/525) met the remission criteria at baseline. The linear mixed-model analysis showed that patients who had symptomatic remission were employed 0.69 of a month longer ( p = 0.04) and earned NT$2,490 more ( p = 0.03) within 1 year than did those who did not show symptomatic remission. For finding factors related to employment outcomes in patients without remission, initial IADL scores were significantly associated with both outcomes (B = 0.089, p = 0.001 and B =153, p = 0.003 for cumulative duration and income).Conclusion: Our study suggests that assessing symptomatic remission is an useful part of monitoring treatment effectiveness for schizophrenia, and all strategies targeting the bio-psycho-social domains to attain symptomatic remission are paramount to maintain favorable employment outcomes. To enhance the level of instrumental daily activities is an important issue for schizophrenia patients to return to the community with promising employment outcomes.

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Section: Discussionsupporting

confidence: 93%

Symptomatic remission in schizophrenia affects employment outcomes; Instrumental activity of daily living is a determinant for non-remitted patients

Wang¹,

Wang²,

Chang³

et al. 2020

Preprint

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“…Negative symptoms are consistently associated with functional capacity and real-world functioning, but there is mixed evidence about the relationship of positive and depressive symptoms with both types of functioning (Bowie et al, 2006(Bowie et al, , 2008Evans et al, 2003;Harvey et al, 2003;Palmer et al, 2002;Twamley et al, 2002). Increased number of psychiatric hospital admissions also appears related to poorer performance of instrumental activities of daily living (IADLs) in the community after controlling for cognitive functioning (Lipskaya-Velikovsky, Kotler, Easterbrook, & Jarus, 2015).…”

Section: Clinical Presentationmentioning

confidence: 99%

Evaluating capacities in persons with serious mental illness.

Strong¹,

Ludwin²,

Fish³

2020

Assessing Capacities of Older Adults: A Casebook to Guide Difficult Decisions.

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Capacity for psychiatric treatment consent and independent living are com mon concerns in working with individuals with schizophrenia in an inpatient psychiatric setting.• Core symptoms of schizophrenia, such as cognitive deficits, negative symp toms (e.g., apathy or impoverished speech), and positive symptoms (e.g., delusions or thought disorder), may compromise capacity in different ways.• Capacity evaluations for individuals in inpatient psychiatric settings may present multiple challenges, including but not limited to assessment in the context of psychiatric instability, the establishment and maintenance of rap port, and the assessment and optimization of task engagement. DEFINITION OF THE ISSUEPersons with schizophrenia may experience diminished decision-making and functional capacity. Common domains of concern in this population, particularly in an inpatient psychiatric setting, include the capacity to consent to psychiatric treatment and the capacity to live independently. An evaluation of decision-making capacity in adults and older adults with schizophrenia in anCopyright American Psychological Association. Not for further distribution. Symptom ProfileSchizophrenia and its variants are distinguished symptomatically from other mental health disorders by their prominent positive (e.g., thought disorder, hallucinations, and delusions) and negative (e.g., deficits in motivation, pleasure, speech, and emotion expression) symptoms. The Diagnostic and Statistical Manual of Mental Disorders (fifth ed.; DSM-5; American Psychiatric Association, 2013) presents a commonly used classification system for differentiating schizophrenia and its variants, which include delusional disorder, brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, and schizotypal personality disorder (American Psychiatric Association, 2013). Although all of the diagnoses, except schizotypal personality disorder, share an emphasis on the presence of delusions or hallucinations (or both), the diagnoses are largely differentiated from one another by the presence, prominence, or duration of these and other positive and negative symptoms. Symptom Onset and CourseSchizophrenia occurs in approximately 4.0 per 1,000 individuals over their lifetime (Saha, Chant, Welham, & McGrath, 2005), and the prevalence in older adults may be similar to that in young adults (Meesters et al., 2012). Although schizophrenia is associated with a shorter life expectancy (Olfson, Gerhard, Huang, Crystal, & Stroup, 2015), many individuals with schizophrenia will become older adults, as the number of aging individuals with a schizophrenia diagnosis is increasing in concert with the general aging of the population (Cohen et al., 2000).

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