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BMC Psychiatry
Published in: BMC Psychiatry 1/2020

Open Access 01-12-2020 | Schizophrenia | Research article

Symptomatic remission affects employment outcomes in schizophrenia patients

Authors: San-Ping Wang, Jung-Der Wang, Jer-Hao Chang, Bo-Jian Wu, Tso-Jen Wang, Hsiao-Ju Sun

Published in: BMC Psychiatry | Issue 1/2020

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Abstract

Background

Remission criteria were proposed by Andreasen et al. 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 explored whether symptomatic remission is significantly associated with employment outcomes in a two-year longitudinal study.

Methods

All 525 stable patients with schizophrenia in the therapeutic community of a public mental hospital in Taiwan were recruited between 2013 and 2015. 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 periods 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, psychosocial functioning and initial employment type.

Results

The average age of patients 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 0.8 of a month longer (p = 0.029) and earned NT$3250 more (p = 0.001) within 1 year than those who did not show symptomatic remission.

Conclusion

Our study suggests that assessing symptomatic remission is a useful part of monitoring treatment effectiveness for schizophrenia, and all strategies targeting the bio-psycho-social domains to attain symptomatic remission are paramount to maintaining favorable employment outcomes.
Appendix
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Literature
1.
2.
Jeste DV. A fulfilling year of APA presidency: from DSM-5 to positive psychiatry. Am J Psychiatry. 2013;170(10):1102–5.PubMed
3.
Jeste DV, Lieberman EJA, Fassler D, Peele R. Diagnostic and statistical manual of mental disorders (DSM-5®). 5th ed. Washington DC: American Psychiatric Association; 2013.
4.
Bowie CR, Leung WW, Reichenberg A, McClure MM, Patterson TL, Heaton RK, et al. Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry. 2008;63(5):505–11.PubMedCrossRef
5.
Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"? Schizophr Bull. 2000;26(1):119–36.PubMedCrossRef
6.
Greenwood KE, Landau S, Wykes T. Negative symptoms and specific cognitive impairments as combined targets for improved functional outcome within cognitive remediation therapy. Schizophr Bull. 2005;31(4):910–21.PubMedCrossRef
7.
Elvevag B, Goldberg TE. Cognitive impairment in schizophrenia is the core of the disorder. Crit Rev Neurobiol. 2000;14(1):1–21.PubMedCrossRef
8.
Fasseeh A, Nemeth B, Molnar A, Fricke FU, Horvath M, Koczian K, et al. A systematic review of the indirect costs of schizophrenia in Europe. Eur J Public Health. 2018;28(6):1043-9.
9.
Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
10.
Andreasen NC, William T, Carpenter J, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 2005;162(3):441–9.PubMedCrossRef
11.
Marchesi C, Affaticati A, Monici A, De Panfilis C, Ossola P, Tonna M. Predictors of symptomatic remission in patients with first-episode schizophrenia: a 16years follow-up study. Compr Psychiatry. 2014;55(4):778–84.PubMedCrossRef
12.
Schennach-Wolff R, Jager M, Seemuller F, Obermeier M, Messer T, Laux G, et al. Defining and predicting functional outcome in schizophrenia and schizophrenia spectrum disorders. Schizophr Res. 2009;113(2–3):210–7.PubMedCrossRef
13.
Karow A, Moritz S, Lambert M, Schottle D, Naber D, Initiative E. Remitted but still impaired? Symptomatic versus functional remission in patients with schizophrenia. Eur Psychiatry. 2012;27(6):401–5.PubMedCrossRef
14.
Valencia M, Fresan A, Barak Y, Juarez F, Escamilla R, Saracco R. Predicting functional remission in patients with schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome. Neuropsychiatr Dis Treat. 2015;11:2339–48.PubMedPubMedCentralCrossRef
15.
Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV social and occupational functioning assessment scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101(4):323–9.PubMed
16.
Llorca PM, Lancon C, Lancrenon S, Bayle FJ, Caci H, Rouillon F, et al. The "functional remission of general schizophrenia" (FROGS) scale: development and validation of a new questionnaire. Schizophr Res. 2009;113(2–3):218–25.PubMedCrossRef
17.
Lancon C, Bayle FJ, Llorca PM, Rouillon F, Caci H, Lancrenon S, et al. Time-stability of the "functional remission of general schizophrenia" (FROGS) scale. Eur Psychiatry. 2012;27(6):437–41.PubMedCrossRef
18.
Robinson DG, Woerner MG, McMeniman M, Mendelowitz A, Bilder RM. Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry. 2004;161(3):473–9.PubMedCrossRef
19.
Helldin L, Kane JM, Karilampi U, Norlander T, Archer T. Remission in prognosis of functional outcome: a new dimension in the treatment of patients with psychotic disorders. Schizophr Res. 2007;93(1–3):160–8.PubMedCrossRef
20.
World Health Organization. International classification of functioning, disability and health: ICF. Geneva: World Health Organization; 2001.
21.
Świtaj P, Anczewska M, Chrostek A, Sabariego C, Cieza A, Bickenbach J, et al. Disability and schizophrenia: a systematic review of experienced psychosocial difficulties. BMC Psychiatry. 2012;12(1):193.PubMedPubMedCentralCrossRef
22.
Martini LC, Barbosa JBN, Petreche B, Fonseca AO, Santos FVD, Magalhaes L, et al. Schizophrenia and work: aspects related to job acquisition in a follow-up study. Rev Bras Psiquiatr. 2018;40:35–40.PubMedCrossRef
23.
Ucok A, Serbest S, Kandemir PE. Remission after first-episode schizophrenia: results of a long-term follow-up. Psychiatry Res. 2011;189(1):33–7.PubMedCrossRef
24.
Guo X, Zhang Z, Zhai J, Fang M, Hu M, Wu R, et al. Effects of antipsychotic medications on quality of life and psychosocial functioning in patients with early-stage schizophrenia: 1-year follow-up naturalistic study. Compr Psychiatry. 2012;53(7):1006–12.PubMedCrossRef
25.
Keefe RS. Cognitive deficits in patients with schizophrenia: effects and treatment. J Clin Psychiatry. 2007;68(Suppl 14):8–13.PubMed
26.
Crowther R, Marshall M, Bond G, Huxley P. Vocational rehabilitation for people with severe mental illness. Cochrane Database Syst Rev. 2001;2:CD003080.
27.
Mohr P, Rodriguez M, Bravermanova A, Melicher T, Ceplova Z, Cermak J, et al. Social and functional capacity of schizophrenia patients: a cross-sectional study. Int J Soc Psychiatry. 2014;60(4):352–8.PubMedCrossRef
28.
Tsang HWH, Leung AY, Chung RCK, Bell M, Cheung W. Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust N Z J Psychiatry. 2010;44(6):495–504.PubMed
29.
Reddy LF, Llerena K, Kern RS. Predictors of employment in schizophrenia: the importance of intrinsic and extrinsic motivation. Schizophr Res. 2016;176(2–3):462–6.PubMedCrossRef
30.
Haynes VS, Zhu B, Stauffer VL, Kinon BJ, Stensland MD, Xu L, et al. Long-term healthcare costs and functional outcomes associated with lack of remission in schizophrenia: a post-hoc analysis of a prospective observational study. BMC Psychiatry. 2012;12:222.PubMedPubMedCentralCrossRef
31.
Carmona VR, Gómez-Benito J, Huedo-Medina TB, Rojo JE, Gómez-Benito J. Employment outcomes for people with schizophrenia spectrum disorder: a meta-analysis of randomized controlled trials. Int J Occup Med Environ Health. 2017;30(3):345–66.PubMed
32.
Wu BJ, Lin CH, Tseng HF, Liu WM, Chen WC, Huang LS, et al. Validation of the Taiwanese mandarin version of the personal and social performance scale in a sample of 655 stable schizophrenic patients. Schizophr Res. 2013;146(1–3):34–9.PubMedCrossRef
33.
Horacek J, Bubenikova-Valesova V, Kopecek M, Palenicek T, Dockery C, Mohr P, et al. Mechanism of action of atypical antipsychotic drugs and the neurobiology of schizophrenia. CNS Drugs. 2006;20(5):389–409.PubMedCrossRef
34.
Wu BJ, Lan TH, Hu TM, Lee SM, Liou JY. Validation of a five-factor model of a Chinese mandarin version of the positive and negative syndrome scale (CMV-PANSS) in a sample of 813 schizophrenia patients. Schizophr Res. 2015;169(1–3):489–90.PubMedCrossRef
35.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13.
36.
Guo N-W, Liu H-C, Wong P-F, Liao K-K, Yan S-H, Lin K-P, et al. Chinese version and norms of the mini-mental state examination. J Rehabil Med Assoc. 1988;16:52–9.
37.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed
38.
Brown H, Prescott R. Applied mixed models in medicine. 2nd ed. Hoboken: Wiley; 2006. .
39.
Abdi H. Holm's sequential Bonferroni procedure. Encyclopedia of research design, 1; 2010.
40.
Burns T, Catty J, Becker T, Drake RE, Fioritti A, Knapp M, et al. The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet. 2007;370(9593):1146–52.PubMedCrossRef
41.
Bio DS, Gattaz WF. Vocational rehabilitation improves cognition and negative symptoms in schizophrenia. Schizophr Res. 2011;126(1–3):265–9.PubMedCrossRef
42.
Dahlan R, Midin M, Shah SA, Nik Jaafar NR, Abdul Rahman FN, Baharudin A, et al. Functional remission and employment among patients with schizophrenia in Malaysia. Compr Psychiatry. 2014;55(Suppl 1):S46–51.PubMedCrossRef
43.
Charzyńska K, Kucharska K, Mortimer A. Does employment promote the process of recovery from schizophrenia? A review of the existing evidence. Int J Occup Med Environ Health. 2015;28(3):407–18.PubMedCrossRef
44.
Jordan G, Lutgens D, Joober R, Lepage M, Iyer SN, Malla A. The relative contribution of cognition and symptomatic remission to functional outcome following treatment of a first episode of psychosis. J Clin Psychiatry. 2014;75(6):e566–72.PubMedCrossRef
45.
Rosenheck R, Leslie D, Keefe R, McEvoy J, Swartz M, Perkins D, et al. Barriers to employment for people with schizophrenia. Am J Psychiatry. 2006;163(3):411–7.PubMedCrossRef
46.
Boden R, Sundstrom J, Lindstrom E, Lindstrom L. Association between symptomatic remission and functional outcome in first-episode schizophrenia. Schizophr Res. 2009;107(2–3):232–7.PubMedCrossRef
47.
Harvey PD, Bellack AS. Toward a terminology for functional recovery in schizophrenia: is functional remission a viable concept? Schizophr Bull. 2009;35(2):300–6.PubMedPubMedCentralCrossRef
48.
Oorschot M, Lataster T, Thewissen V, Lardinois M, van Os J, Delespaul PAEG, et al. Symptomatic remission in psychosis and real-life functioning. Br J Psychiatry. 2012;201(3):215–20.PubMedCrossRef
49.
Feher EP, Mahurin RK, Doody RS, Cooke N, Sims J, Pirozzolo FJ. Establishing the limits of the mini-mental state. Examination of 'subtests'. Arch Neurol. 1992;49(1):87–92.PubMedCrossRef
50.
Spencer RJ, Wendell CR, Giggey PP, Katzel LI, Lefkowitz DM, Siegel EL, et al. Psychometric limitations of the mini-mental state examination among nondemented older adults: an evaluation of neurocognitive and magnetic resonance imaging correlates. Exp Aging Res. 2013;39(4):382–97.PubMedCrossRef
51.
Nuechterlein KH, Green MF, Kern RS, Baade LE, Barch DM, Cohen JD, et al. The MATRICS consensus cognitive battery, part 1: test selection, reliability, and validity. Am J Psychiatry. 2008;165(2):203–13.PubMedCrossRef
52.
Keefe RS, Goldberg TE, Harvey PD, Gold JM, Poe MP, Coughenour L. The brief assessment of cognition in schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res. 2004;68(2–3):283–97.PubMedCrossRef
53.
Shamsi S, Lau A, Lencz T, Burdick KE, DeRosse P, Brenner R, et al. Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophr Res. 2011;126(1–3):257–64.CrossRefPubMed
54.
55.
Puig O, Penades R, Gasto C, Catalan R, Torres A, Salamero M. Verbal memory, negative symptomatology and prediction of psychosocial functioning in schizophrenia. Psychiatry Res. 2008;158(1):11–7.PubMedCrossRef
56.
Vesterager L, Christensen TO, Olsen BB, Krarup G, Melau M, Forchhammer HB, et al. Cognitive and clinical predictors of functional capacity in patients with first episode schizophrenia. Schizophr Res. 2012;141(2–3):251–6.PubMedCrossRef
57.
Abdi H. Partial least squares (PLS) regression. In Lewis-Beck M, et al. (eds), Encyclopedia of social sciences research methods. Oak: Sage; 2003. p. 792-5. .
Metadata
Title
Symptomatic remission affects employment outcomes in schizophrenia patients
Authors
San-Ping Wang
Jung-Der Wang
Jer-Hao Chang
Bo-Jian Wu
Tso-Jen Wang
Hsiao-Ju Sun
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-02630-z

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