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Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment

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Abstract

This longitudinal study aimed at identifying predictors of community outcome from a broad range of neuropsychological, clinical psychopathologic, sociodemographic, and treatment related factors. N = 96 schizophrenia patients were assessed both at baseline during inpatient treatment and 1 year after discharge from hospital (follow-up). At follow-up functional outcome was measured by the Global Assessment of Functioning Scale (GAF) and the Social Adjustment Scale II (SAS II). Data were analyzed in an explorative way by means of multiple linear regression analyses. Three out of the five functional outcome measures were predicted by the negative syndrome and measures of cognitive functioning. However, the positive syndrome also consistently predicted psychosocial functioning. Altogether, the regression models explained between 20% and 35% of the variance in our outcome measures. The findings not only reemphasize that negative symptoms and cognitive dysfunctions are key determinants of community outcome but also point to a potential predictive relevance of positive symptoms.

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References

  1. Addington J, Addington D (1999) Neurocognitive and social functioning in Schizophrenia. Schizophr Bull 25:172–182

    Google Scholar 

  2. Addington J, McCleary L, Munroe-Blum H (1998) Relationship between cognitive and social dysfunction in schizophrenia. Schizophr Res 34:59–66

    Article  PubMed  CAS  Google Scholar 

  3. Bach P, Hayes SC (2002) The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. J Consult Clin Psychol 70:1129–1139

    Article  PubMed  Google Scholar 

  4. Bachmann S, Bottmer C, Essig M, Magnotta V, Schroder J (2007) Compliance with medication but not structural MRI measures predict functional outcome in first-episode schizophrenia patients. Schizophr Res 90:355–356

    Article  PubMed  Google Scholar 

  5. Breier A, Schreiber JL, Dyer J, Picker D (1991) National institute of mental health longitudinal study of chronic schizophrenia. Prognosis and predictors of outcome. Arch Gen Psychiatry 48:239–246

    PubMed  CAS  Google Scholar 

  6. Buchkremer G, Klingberg S, Holle R, Schulze Mönking H, Hornung WP (1997) Psychoeducational psychotherapy for schizophrenic patients and their key relatives or care-givers: results of a 2-year follow-up. Acta Psychiatr Scand 96:483–491

    Article  PubMed  CAS  Google Scholar 

  7. Bustillo J, Lauriello J, Horan W, Keith S (2001) The psychosocial treatment of schizophrenia: an update. Am J Psychiatry 158:163–175

    Article  PubMed  CAS  Google Scholar 

  8. Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum, Hillsdale

    Google Scholar 

  9. Cohen J (1992) A power primer. Psychol Bull 112:155–159

    Article  PubMed  CAS  Google Scholar 

  10. Corrigan PW, Green MF, Toomey R (1994) Cognitive correlates to social cue perception in schizophrenia. Psychiatry Res 53:141–151

    Article  PubMed  CAS  Google Scholar 

  11. Davis JM (1974) Dose equivalence of the antipsychotic drugs. J Psychiatric Res 11:65–69

    Article  CAS  Google Scholar 

  12. Dickerson F, Boronow JJ, Ringel N, Parente F (1996) Neurocognitive deficits and social functioning in outpatients with schizophrenia. Schizophr Res 21:75–83

    Article  PubMed  CAS  Google Scholar 

  13. Dickerson F, Boronow JJ, Ringel N, Parente F (1999) Social functioning and neurocognitive deficits in outpatients with schizophrenia: a 2-year follow-up. Schizophr Res 37:13–20

    Article  PubMed  CAS  Google Scholar 

  14. Erdfelder E, Faul F, Buchner A (1996) GPOWER: a general power analysis program. Behav Res Methods, Instrum Comput 28:1–11

    Google Scholar 

  15. Faul F, Erdfelder E (1992) GPOWER: a priori, post-hoc, and compromise power analyses for MS-DOS [Computer program; Version 2.0]. University of Bonn, Department of Psychology, Bonn (Germany)

    Google Scholar 

  16. Goldberg TE, Gold JM (1995) Neurocognitive deficits in schizophrenia. In: Hirsch S, Weinberger DR (eds) Schizophrenia. Blackwell Science, Oxford, pp 146–162

    Google Scholar 

  17. Green MF (1996) What are the functional consequences of neurocognitive deficits in schizophrenia. Am J Psychiatry 153:321–330

    PubMed  CAS  Google Scholar 

  18. Green MF, Kern RS, Braff DL, Mintz J (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophr Bull 26:119–136

    PubMed  CAS  Google Scholar 

  19. Green MF, Nuechterlein KH (1999) Should Schizophrenia be treated as a neurocognitive disorder? Schizophr Bull 25:309–318

    PubMed  CAS  Google Scholar 

  20. Green MF, Kern RS, Heaton RK (2004) Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res 72:41–51

    Article  PubMed  Google Scholar 

  21. Gumley A, O’Grady M, McNay L, Reilly J, Power K, Norrie J (2003) Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychol Med 33:419–431

    Article  PubMed  CAS  Google Scholar 

  22. Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G (1993) Wisconsin card sorting test Manual, revised and expanded. Psychological Assessment Resources, Odessa, Florida

    Google Scholar 

  23. Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12:426–445

    Article  PubMed  CAS  Google Scholar 

  24. Herz MI, Lamberti S, Mintz J, Scott R, O’Dell SP, McCartan L, Nix G (2000) A program for relapse prevention in schizophrenia. A controlled study. Arch Gen Psychiatry 57:277–283

    Article  PubMed  CAS  Google Scholar 

  25. Heubrock D (1992) Der Auditiv-Verbale Lerntest (AVLT) in der klinischen und experimentellen Neuropsychologie. Durchführung, Auswertung und Forschungsergebnisse. Zeitschrift für Differentielle und Diagnostische Psychologie 3:161–174

    Google Scholar 

  26. Ho BC, Nopoulos P, Flaum M, Arndt S, Andreasen NC (1998) Two-year outcome in fist-episode schizophrenia: predictive value of symptoms for quality of life. Am J Psychiatry 155:1196–1201

    PubMed  CAS  Google Scholar 

  27. Hofer A, Baumgartner S, Bodner T, Edlinger M, Hummer M, Kemmler G (2005) Patient outcomes in schizophrenia II: the impact of cognition. Eur Psychiatry 20:395–402

    Article  PubMed  Google Scholar 

  28. Hofer A, Baumgartner S, Edlinger M, Hummer M, Kemmler G, Rettenbacher MA (2005) Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects. Eur Psychiatry 20:386–394

    Article  PubMed  Google Scholar 

  29. Hofer A, Rettenbacher MA, Widschwendter CG, Kemmler G, Hummer M, Fleischhacker WW (2006) Correlates of subjective and functional outcomes in outpatient clinic attendees with schizophrenia and schizoaffective disorder. Eur Arch Psychiatry Clin Neurosci 256:246–255

    Article  PubMed  Google Scholar 

  30. Hogarty GE, Kornblith SJ, Greenwald D, DiBarry AL, Cooley S, Ulrich RF, Carter M, Flesher S (1997) Three-year trials of personal therapy among schizophrenic patients living with or independent of family, I: description of study and effects on relapse rates. Am J Psychiatry 154:1504–1513

    PubMed  CAS  Google Scholar 

  31. Horn W (1983) Leistungsprüfsystem. LPS. Hogrefe, Göttingen

    Google Scholar 

  32. Ikebuchi E, Nakagome K, Tugawa R, Asada Y, Mori K, Takahashi N, Takazawa S, Ichikawa I, Akaho R (1996) What influences social skills in patients with schizophrenia? Preliminary study using the role play test, WAIS-R and event-related potential. Schizophr Res 22:143–150

    Article  PubMed  CAS  Google Scholar 

  33. Johnstone EC, Macmillan JF, Frith CD, Benn DK, Crow TJ (1990) Further investigation of the predictors of outcome following first schizophrenic episodes. Br J Psychiatry 157:182–189

    Article  PubMed  CAS  Google Scholar 

  34. Jones C, Cormac I, Silveira da Mota Neto J, Campbell C (2005) Cognitive behaviour therapy for schizophrenia (cochrane-Review), Vol 3. The Cochrane Library, Oxford

    Google Scholar 

  35. Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    PubMed  CAS  Google Scholar 

  36. Kemp R, Hayward P, Applewhaite G, Everitt B, David A (1996) Compliance therapy in psychotic patients: randomised controlled trial. BMJ 312:345–349

    PubMed  CAS  Google Scholar 

  37. Kemp R, Kirov G, Everitt B, Hayward P, David A (1998) Randomised controlled trial of compliance therapy. 18-Month follow-up. Br J Psychiatry 172:413–419

    Article  PubMed  CAS  Google Scholar 

  38. Keshavan MS, Haas G, Miewald J, Montrose DM, Reddy R, Schooler NR, Sweeney JA (2003) Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychoses. Schizophr Bull 29:757–769

    PubMed  Google Scholar 

  39. Klingberg S, Wittorf A, Wiedemann G (2006) Disorganization and cognitive impairment in schizophrenia: independent symptom dimensions? Eur Arch Psychiatry Clin Neurosci 256:532–540

    Article  PubMed  Google Scholar 

  40. Leary J, Johnstone EC, Owen DGC (1991) Social outcome. Br J Psychiatry 159(Suppl 13):13–20

    Google Scholar 

  41. Lehman AF, Goldberg R, Dixon LB, McNary S, Postrado L, Hackman A (2002) Improving employment outcomes for persons with severe mental illnesses. Arch Gen Psychiatry 59:165–172

    Article  PubMed  Google Scholar 

  42. Lehrl S (1992) Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B). Perimed-spitta, Nürnberg

    Google Scholar 

  43. Leung A, Chue P (2000) Sex differences in schizophrenia, a review of the literature. Acta Psychiatr Scand 101:3–38

    Article  Google Scholar 

  44. Lysaker PH, Bell MD, Bioty SM (1995) Cognitive deficits in schizophrenia. Prediction of symptom change for participators in work rehabilitation. J Nerv Ment Dis 183:332–336

    Article  PubMed  CAS  Google Scholar 

  45. Meyers JE, Meyers KR (1995) Rey complex figure test and recognition trial. Professional manual. Psychological Assessment Resources, Odessa, FL

    Google Scholar 

  46. Mueser KT (2000) Cognitive functioning, social adjustment, and longterm outcome in schizophrenia. In: Sharma T, Harvey P (eds) Cognition in schizophrenia. Oxford University Press, New York, pp 157–177

    Google Scholar 

  47. Müller P (1999) Therapie der Schizophrenie. Integrative Behandlung in Klinik, Praxis und Rehabilitation. Thieme, Stuttgart

    Google Scholar 

  48. Norman RM, Malla AK, Cortese L, Cheng S, Diaz K, McIntosh E (1999) Symptoms and cognition as predictors of community functioning. A prospective analysis. Am J Psychiatry 156:400–405

    PubMed  CAS  Google Scholar 

  49. Nuechterlein KH, Asarnow RF (1996) Continuous Performance Test (CPT). Program for IBM_Compatible Microcomputers. Version 7.10, Los Angeles, CA

  50. Pilling S, Bebbington P, Kuipers E, Garety P, Geddes J, Martindale B, Orbach G, Morgan C (2002) Psychological treatments in schizophrenia: II. Meta-analysis of randomized controlled trials of social skills training and cognitive remediation. Psychol Med 32:783–791

    Article  PubMed  CAS  Google Scholar 

  51. Pilling S, Bebbington P, Kuipers E, Garety P, Geddes J, Orbach G, Morgan C (2002) Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 32:763–782

    Article  PubMed  CAS  Google Scholar 

  52. Racenstein JM, Harrow M, Reed R, Martin E, Herbener E, Penn DL (2002) The relationship between positive symptoms and instrumental work functioning in schizophrenia: A 10 year follow-up study. Schizophr Res 56:95–103

    Article  PubMed  Google Scholar 

  53. Rector NA, Beck AT (2001) Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 189:278–287

    Article  PubMed  CAS  Google Scholar 

  54. Reitan RM (1992) Trail making test. Reitan Neuropsychology Laboratory, South Tucson, Arizona

    Google Scholar 

  55. Rund BR (1983) The effect of distraction on focal attention in paranoid and non-paranoid schizophrenic patients compared to normals and non-psychotic psychiatric patients. J Psychiatr Res 17:241–250

    Article  CAS  Google Scholar 

  56. Sass H, Wittchen HU, Zaudig M (1996) Diagnostisches und Statistisches Manual Psychischer Störungen—DSM IV. Übersetzt nach der vierten Auflage des Diagnostic and Statistical Manual of Mental Disorders der American Psychiatric Association. Hogrefe, Göttingen

    Google Scholar 

  57. Schooler NR, Hogarty GE, Weissman MM (1979) Social adjustment scale II (SAS II). In: Hargreaves WA (ed) Materials for community mental health program evaluators. US Department of Health & Human Services, Washington DC, pp 290–302

    Google Scholar 

  58. Silverstein ML, Zervick MJ (1985) Clinical psychopathologic symptoms in neuropsychologically impaired and intact schizophrenics. J Consult Clin Psychol 53:288–296

    Google Scholar 

  59. Simpson G, Angus J (1970) A rating scale for extrapyramidal side effects. Acta Psychiatr Scand 212:11–19

    Article  CAS  Google Scholar 

  60. Tewes U (1994) HAWIE-R. Hamburg-Wechsler Intelligenztest für Erwachsene. Revision 1991. Huber, Bern, Stuttgart

    Google Scholar 

  61. Thornicroft G, Tansella M, Becker M, Knapp M, Leese M, Schene A (2004) The personal impact of schizophrenia in Europe. Schizophr Res 69:125–132

    Article  PubMed  Google Scholar 

  62. Velligan DI, Mahurin RK, Diamond PL, Hazleton BC, Eckert SL, Miller AL (1997) The functional significance of symptomatology and cognitive function in schizophrenia. Schizophr Res 25:21–31

    Article  PubMed  CAS  Google Scholar 

  63. Weickert TW, Goldberg TE, Gold JM, Bigelow LB, Egan MF, Weinberger DR (2000) Cognitive impairments in patients with schizophrenia displaying preserved and compromised intellect. Arch Gen Psychiatry 57:907–913

    Article  PubMed  CAS  Google Scholar 

  64. Wittchen HU, Zaudig M, Fydrich T (1997) SKID. Strukturiertes Klinisches Interview für DSM-IV. Achse I und II. Hogrefe, Göttingen

    Google Scholar 

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Acknowledgments

This study was supported by the German Research Foundation (DFG), project number DFG Wi 1523/1-1, 1523/1-3, and Kl 1179/1-4 and by the research support program of the university hospital of Tuebingen (fortuene), project number 594-0-0 and 594-0-1.

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  1. Dept. of Psychiatry and Psychotherapy, University of Tuebingen, Osiander Str. 24, 72076, Tuebingen, Germany

    Andreas Wittorf PhD, MA, Gerhard Buchkremer & Stefan Klingberg

  2. Dept. of Psychiatry and Psychotherapy, University of Frankfurt, Frankfurt, Germany

    Georg Wiedemann

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  1. Andreas Wittorf PhD, MA
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Correspondence to Andreas Wittorf PhD, MA.

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Wittorf, A., Wiedemann, G., Buchkremer, G. et al. Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment. Eur Arch Psychiatry Clin Neurosc 258, 48–58 (2007). https://doi.org/10.1007/s00406-007-0761-z

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  • DOI: https://doi.org/10.1007/s00406-007-0761-z

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