Comparison between the effects of atypical and traditional antipsychotics on work status for clients in a psychiatric rehabilitation program.

Background: Although many studies have compared the impact of atypical antipsychotics with that of traditional antipsychotics on psychiatric symptoms, few have compared the impact on work status, especially in the context of best-practices psychiatric rehabilitation.

Method: A cross-sectional design examined symptom and employment status for 82 clients with DSM-IV schizophrenia-spectrum disorders who had attended a psychiatric rehabilitation program for a mean of 5 years. Using chart review and client interviews, we examined the relationship between type of antipsychotic prescribed and symptom and work status in 59 clients prescribed an atypical antipsychotic (olanzapine or risperidone) for a mean of 20 months and 23 clients prescribed a traditional antipsychotic for a mean of 75 months. Measures included the Positive and Negative Syndrome Scale and 2 work status measures: an 8-point employment status scale (the Work Placement Scale) and percentage of clients working in independent employment.

Results: The atypical group had significantly fewer symptoms of cognitive impairment and hostility/excitement than the traditional group (p < .05). However, self-reported adverse events were similar in the 2 medication groups, and the 2 groups did not differ significantly on work status. Less severe negative, cognitive, and hostility/excitement symptoms were associated with more independent employment status.

Conclusion: For long-term clients in a psychiatric rehabilitation program, type of medication prescribed was associated with better symptom control but not better work status. The association between symptoms and work status, however, may suggest an indirect link favoring atypical antipsychotics for achieving paid employment.