Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Australia.
Schizophr Res. 2013 Oct;150(1):136-43. doi: 10.1016/j.schres.2013.07.047. Epub 2013 Aug 12.
To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6 months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU).
135 FEP participants (IPS n=69; TAU n=66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6 months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group.
Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6 months was predicted by enrolment in education at baseline (p=.002) and poorer visual organisation and memory (p=.024). Employment over 6 months was predicted by employment at baseline (p=.041) and receiving IPS (p=.020). Better visual organisation and memory predicted total hours of paid work over 6 months (p<.001).
Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP.
在一项个体化就业支持（IPS）与常规治疗（TAU）的随机对照试验中，考察首发精神病（FEP）患者的基线神经认知和社会认知是否能预测 6 个月时的职业结果。
135 名 FEP 参与者（IPS 组 n=69；TAU 组 n=66）完成了全面的神经认知和社会认知测试。采用 PROMAX 旋转的主成分因子分析确定电池的潜在认知结构。采用逐步（分层）逻辑回归和多元线性回归来检验以下预测因子：（a）参与教育和就业；以及（b）6 个月内的就业时间。在考虑到前驱智商、基线功能和治疗组后，将神经认知和社会认知因素纳入模型。
提取了 6 个认知因素：（i）社会认知；（ii）信息处理速度；（iii）言语学习和记忆；（iv）注意力和工作记忆；（v）视觉组织和记忆；以及（vi）言语理解。6 个月内的教育入学由基线时的教育入学（p=.002）和较差的视觉组织和记忆（p=.024）预测。6 个月内的就业由基线时的就业（p=.041）和接受 IPS（p=.020）预测。更好的视觉组织和记忆预测了 6 个月内的总工作时间（p<.001）。
在考虑到前驱智商、基线功能和治疗后，视觉组织和记忆预测了教育入学和就业时间。社会认知对职业结果的预测没有贡献。神经认知干预可能会延长 FEP 患者的就业时间。
