Tan Bhing-Leet
Occupational Therapy Department, Institute of Mental Health, Singapore.
Aust Occup Ther J. 2009 Aug;56(4):220-8. doi: 10.1111/j.1440-1630.2008.00759.x.
This literature review attempts to profile specific areas of cognition that have shown unique and consistent evidence of dysfunction among people with schizophrenia. In addition, their impact on vocational functioning is illustrated, so as to highlight the importance of managing these cognitive difficulties in vocational rehabilitation.
Literature search was carried out on seven key cognitive domains identified by the National Institute of Mental Health in the USA. Their impact on vocational function was also reviewed.
It is found that attention, declarative and working memory, reasoning, problem-solving and social cognition are areas of impairment that have great impact on vocational functioning. Attention and memory problems affect learning of new work tasks. Executive function is particularly crucial in determining supported and open employment outcomes, as executive dysfunction cannot be easily compensated. Lastly, social cognition plays a major role in determining the success of workplace social exchanges.
Occupational therapists need to have a good understanding of the profile of cognitive problems among people with schizophrenia, in order to tailor our intervention according to their cognitive strengths and difficulties. Several cognitive remediation strategies and programs have been designed specifically for people with mental illness. Equipping ourselves with skills in conducting such programs will augment our expertise in vocational rehabilitation.
本综述旨在概述精神分裂症患者中已显示出独特且一致功能障碍证据的特定认知领域。此外，还阐述了这些认知领域对职业功能的影响，以突出在职业康复中应对这些认知困难的重要性。
对美国国立精神卫生研究所确定的七个关键认知领域进行文献检索。同时也回顾了它们对职业功能的影响。
研究发现，注意力、陈述性记忆和工作记忆、推理、问题解决能力以及社会认知是受损领域，对职业功能有重大影响。注意力和记忆问题会影响新工作任务的学习。执行功能在决定支持性就业和开放性就业结果方面尤为关键，因为执行功能障碍不易得到代偿。最后，社会认知在决定职场社交互动的成功方面起着重要作用。
职业治疗师需要充分了解精神分裂症患者的认知问题概况，以便根据他们的认知优势和困难来调整干预措施。已经专门为精神疾病患者设计了几种认知康复策略和项目。掌握开展此类项目的技能将增强我们在职业康复方面的专业能力。
