McGurk Susan R, Mueser Kim T, Harvey Phil D, LaPuglia Richard, Marder Joan
Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
Psychiatr Serv. 2003 Aug;54(8):1129-35. doi: 10.1176/appi.ps.54.8.1129.
This study examined the relationships of measures of cognitive functioning and psychiatric symptoms with work outcomes and use of vocational services for clients with schizophrenia in a supported employment program.
Thirty clients who were newly enrolled in a supported employment program were evaluated with cognitive and symptom measures at program entry and two years later. The clients' amounts of competitive work, wages earned, on-job support, and contact with employment specialists during the two-year follow-up period were documented.
Predictors of clients' work outcomes included previous work history, amount of government entitlement income received, severity of negative symptoms, involvement in sheltered work activity at baseline, and level of cognitive functioning, including scores on measures of executive functioning and verbal learning and memory. The amounts of on-job support and contact with employment specialists were predicted by the cognitive domains of executive functioning, verbal learning, attention, and psychomotor speed as well as by the severity of psychotic symptoms.
Clients with schizophrenia who have higher levels of cognitive impairment may require greater amounts of vocational support than those with lower levels of impairment. A variety of rehabilitation strategies may be required to improve vocational outcomes and reduce the amount of supported employment services needed by clients with schizophrenia.
本研究探讨了在支持性就业项目中，认知功能指标和精神症状与精神分裂症患者的工作成果及职业服务利用情况之间的关系。
对30名新参加支持性就业项目的患者在项目开始时及两年后进行认知和症状评估。记录了这些患者在两年随访期内的竞争性工作量、收入、工作支持情况以及与就业专家的接触情况。
患者工作成果的预测因素包括既往工作经历、获得的政府津贴收入数额、阴性症状的严重程度、基线时参与庇护性工作活动的情况以及认知功能水平，包括执行功能、言语学习和记忆测量的得分。工作支持量和与就业专家的接触情况由执行功能、言语学习、注意力和精神运动速度等认知领域以及精神病性症状的严重程度预测。
认知损害程度较高的精神分裂症患者可能比损害程度较低的患者需要更多的职业支持。可能需要多种康复策略来改善职业成果并减少精神分裂症患者所需的支持性就业服务量。
