Neurocognitive and clinical predictors for vocational outcome following first episode schizophrenia: a 3 year prospective study

Abstract

OBJECTIVE: We aim to identify early clinical and cognitive features that may predict vocational outcomes after first episode schizophrenia in Hong Kong. In addition, we investigated associated effects of unemployment on the symptomatic outcome of the illness at three years. METHOD: We studied the employment history of 93 patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders who was longitudinally followed up over three years. Pre-morbid factors, as well as clinical and cognitive variables which are present at the first episode were studied in relation to subsequent vocational outcomes. The relationship between employment status and clinical outcome at three years was also explored. RESULTS: The median number of months of full time employment is 8 out of 36 months. Forty-one percent of the patients did not return to full-time employment at all. Patient with poor vocational outcome (less than 8 months of full time employment) had more impaired scores on the premorbid adjustment scale (t = 2.889, p = .005) as well as more impaired work functioning at the time of presentation (t = 3.671, p < 0.001). They also performed worse in Logical memory (t = -2.072, p = .04), visual reproduction (t = -2.624, p = .01), as well as in both perseverative errors (t = 2.685, p = .009)and cateogory completion in the Wisconsin Card Sorting Test (t = -2.655, p = .009). A binary logistic regression model suggest that poor vocational outcome is predicted by poor pre-morbid occupational functioning, Premorbid adjustment, and executive function impairment after the first episode. Compared with others, patient with poor vocational outcome showed a decline in negative symptoms over the three year period. CONCLUSION: Vocational outcome is unfavorable after first-episode psychosis. Early predictors for poor outcome may identify at-risk patients for timely intervention. Unemployment is associated with an increase in negative symptoms.