A meta-analysis of cognitive remediation in schizophrenia.

Objective: This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia.

Method: A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients.

Results: Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.

Measuring illness management outcomes: a psychometric study of clinician and consumer rating scales for illness self management and recovery.

Psychometric properties of the Illness Management and Recovery (IMR) Scales (consumer and clinician versions), new 15-item instruments measuring illness self-management and pursuit of recovery goals, were evaluated in consumers with severe mental illness. Both versions had moderate internal consistency and high 2-week test-retest reliability. In addition, the consumer version was correlated with self-ratings of recovery and symptoms, and the clinician version was correlated with clinician ratings of community functioning, indicating convergent validity.

Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial.

Objective: To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia, a cognitive training program, the Thinking Skills for Work Program, was developed and integrated into supported employment services.

Method: Patients with severe mental illness (N=44) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were randomly assigned to receive either supported employment alone or supported employment with cognitive training. Measures at baseline and 3 months included a brief cognitive and symptom assessment.

Correlates of adverse childhood events among adults with schizophrenia spectrum disorders.

Objective: Multiple studies have found that childhood adversity is related to a range of poor mental health, substance abuse, poor physical health, and poor social functioning outcomes in the general population of adults. However, despite the high rates of childhood adversity in schizophrenia, the clinical correlates of these events have not been systematically evaluated. This study evaluated the relationship between adverse experiences in childhood and functional, clinical, and health outcomes among adults with schizophrenia.

The Trauma Recovery Group: a cognitive-behavioral program for post-traumatic stress disorder in persons with severe mental illness.

To address the problem of post-traumatic stress disorder (PTSD) in severe mental illness, the Trauma Recovery Group, a mixed gender cognitive-behavioral program, was developed and piloted at a community mental health center. The 21-week program includes breathing retraining, education about PTSD, cognitive restructuring, coping with symptoms, and making a recovery plan. Eighty clients were assessed at baseline and 41 provided follow-up data.

Strategies for coping with cognitive impairments of clients in supported employment.

Objective: This study evaluated the strategies used by employment specialists to help clients in supported employment programs manage cognitive impairments that interfered with obtaining and keeping jobs.

Methods: Twenty-five supported employment specialists were surveyed to identify strategies they used to help their clients cope with cognitive problems in the domains of attention, psychomotor speed, memory, and problem solving. Then, 50 employment specialists were surveyed to determine whether they used each of the different coping strategies generated in the first part of the study.

Psychosocial interventions for the long-term management of patients with severe mental illness and co-occurring substance use disorder.

People with severe mental illness and co-occurring substance use disorders, also referred to as dual disorders, experience worse outcomes over the long term than people without co-occurring substance abuse. Integrated treatment of both disorders has been shown to be more effective than separate treatments offered in parallel or in sequence. The principles and strategies of integrated dual disorder treatment (IDDT) include integration of treatments for the mental illness and the addiction, use of strategies to engage people in treatment, use of pharmacologic and psychosocial interventions that are matched to the patient's stage of change, and use of a long-term perspective.

Integrated psychological therapy (IPT) for schizophrenia: is it effective?

Against the background of evidence-based treatments for schizophrenia, nowadays the implementation of specific cognitive and behavioral interventions becomes more important in the standard care of these patients. Over the past 25 years, research groups in 9 countries have carried out 30 independent evaluations of Integrated Psychological Therapy (IPT), a group program that combines neurocognitive and social cognitive interventions with social skills approaches for schizophrenic patients. The aim of the present study was to evaluate the effectiveness of IPT under varying treatment and research conditions in academic and nonacademic sites.

Symptom correlates of posttraumatic stress disorder in clients with borderline personality disorder.

Limited research has examined the clinical and functional impact of concurrent posttraumatic stress disorder (PTSD) in people with borderline personality disorder (BPD). Such information is particularly lacking for BPD clients with the most disabling symptoms: those who meet criteria for severe and persistent mental illness. We evaluated individuals with severe mental illness to assess whether PTSD in individuals with BPD was associated with more severe symptoms and impaired functioning than BPD alone and replicated these findings in an independent sample.

Cognitive and clinical predictors of work outcomes in clients with schizophrenia receiving supported employment services: 4-year follow-up.

In a prior study we showed that cognitive functioning was a modest predictor of work and supported employment services over 2-years in 30 clients with schizophrenia, whereas symptoms were not (McGurk et al. (2003). Psychiatric Services, 58, 1129-1135).

Cognitive behavioral therapy for prolonged postdisaster distress.

In this article, we present and illustrate cognitive-behavioral therapy for postdisaster distress. The treatment is for individuals who show more than normal transient stress after disaster and functions as an intermediate step between traditional crisis counseling and longer-term mental health treatments. Thus, it is one part of a larger mental health disaster response and is designed to be implemented no sooner than 60 days post disaster.

Medication nonadherence in older people with serious mental illness: prevalence and correlates.

Medication nonadherence in people with schizophrenia and other serious mental illnesses (SMI) is multidetermined and has been consistently associated with relapse and rehospitalization, but little is known about the prevalence and correlates of nonadherence in older people with SMI. This study evaluated the interrelationships between different measures of medication adherence (including pill counts, self-report, informant report, and attitudes toward medications), and their associations with demographic characteristics, and clinical, functional, skill, and cognitive measures in a group of 72 older people with SMI living in the community. Pill counts of adherence to psychotropic medications were highly correlated with pill counts for nonpsychiatric medications.

Challenges to implementing and sustaining comprehensive mental health service programs.

The President's New Freedom Commission recently concluded that the nation's mental health service delivery system is ill equipped to meet the complex needs of persons with mental illness. A major contributor to this service quality crisis has been the longstanding divergence of research efforts and clinical programs. In this article, the authors begin by describing the unique needs of persons with serious and persisting psychiatric disorders and the evolution of the mental health service system that has attempted to meet these needs.

Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders.

Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD.

Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders.

Objective: Clients with co-occurring severe mental and substance use disorders are at high risk of institutionalization and other adverse outcomes. Although integrated mental health and substance abuse treatment is becoming a standard clinical approach for such clients, the optimal method for delivering integrated treatment remains unclear.

Method: This study compared integrated treatment delivered within two different models of community-based case management (assertive community treatment and standard clinical case management).

Demographic characteristics and employment among people with severe mental illness in a multisite study.

People with psychiatric disabilities experience disproportionately high rates of unemployment. As research evidence is mounting regarding effective vocational programs, interest is growing in identifying subgroup variations. Data from a multisite research and demonstration program were analyzed to identify demographic characteristics associated with employment outcomes, after adjusting for the effects of program, services, and study site.

Psychosocial treatment for first-episode psychosis: a research update.

Objective: This article reviews research on psychosocial treatment for first-episode psychosis.

Method: PsycINFO and MEDLINE were systematically searched for studies that evaluated psychosocial interventions for first-episode psychosis.

Results: Comprehensive (i.

Clinical factors associated with employment among people with severe mental illness: findings from the employment intervention demonstration program.

Research has shown that supported employment programs are effective in helping psychiatric outpatients achieve vocational outcomes, yet not all program participants are able to realize their employment goals. This study used 24 months of longitudinal data from a multisite study of supported employment interventions to examine the relationship of patient clinical factors to employment outcomes. Multivariate random regression analysis indicated that, even when controlling for an extensive series of demographic, study condition (experimental versus control), and work history covariates, clinical factors were associated with individuals' ability to achieve competitive jobs and to work 40 or more hours per month.

The effectiveness of skills training for improving outcomes in supported employment.

Objective: This study evaluated whether a supplementary skills training program improved work outcomes for clients enrolled in supported employment programs.

Methods: Thirty-five recently employed clients with severe mental illness who were receiving supported employment services at a free-standing agency were randomly assigned to participate in either the workplace fundamentals program, a skills training program designed to make work more "successful and satisfying," or treatment as usual. Knowledge of workplace fundamentals (for example, identifying workplace stressors, problem solving, and improving job performance) was assessed at baseline and at nine months; employment outcomes and use of additional vocational services were tracked for 18 months.

Self-efficacy and psychosocial functioning in schizophrenia: a mediational analysis.

The construct of self-efficacy has been hypothesized to mediate the relationship between efforts at coping with psychiatric illness and functional outcome. This study examined whether self-efficacy mediated the relationships between psychosocial functioning and important predictors of functioning: premorbid functioning, negative symptoms, and cognitive functioning. Although self-efficacy was positively associated with psychosocial functioning, it did not mediate the relationships between functioning and the other established predictors.

Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial.

This study examined the effectiveness of cognitive training (the Thinking Skills for Work Program) for improving competitive employment outcomes in persons with severe mental illness who have a history of job failure. Forty-four clients receiving services at 2 inner-city community mental health agencies were randomly assigned (within each site) to receive either cognitive training and supported employment (CT + SE) or supported employment only (SE Only). Retention in the CT + SE program was high (91%).

The effects of yoga on mood in psychiatric inpatients.

The effects of yoga on mood were examined in 13 psychiatric inpatients at New Hampshire Hospital. Participants completed the Profile of Mood States (POMS) prior to and following participation in a yoga class. Analyses indicated that participants reported significant improvements on all five of the negative emotion factors on the POMS, including tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, and confusion-bewilderment.

Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness.

Context: National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment.

Methods: We randomly assigned 1273 outpatients with severe mental illness from 7 states in the United States to an experimental SE program or to a comparison or a services-as-usual condition, with follow-up for 24 months.