The Developmental Processes in Schizophrenic Disorders project involves an ongoing series of longitudinal follow-through studies of individuals with a recent onset of schizophrenia. The proposed new protocol focuses particularly on developmental processes affecting work outcome in this initial period after onset of schizophrenia, drawing on findings that link cognitive deficits in schizophrenia to functional outcome. This initial period precedes any chronic disability patterns and is therefore of particular public health significance. The new protocol will determine the effects on work outcome of an intervention designed to enhance search for appropriate work or schooling and to increase ability to maintain work or school activities more successfully. The protocol will determine the predictors of level of work functioning attained in the context of the new work-focused intervention and maintenance on risperidone. Potential neurocognitive and environmental predictors of work and social functioning and clinical course will be examined. Aspects of early perceptual processing, allocation of attention, working memory, secondary verbal memory, and conceptual flexibility that are implicated as enduring vulnerability factors in schizophrenia and influences on functional outcome will be assessed, as will potential stresses and supportive influences in the environment. Schizophrenic patients from an earlier recent- onset cohort will be reassessed at an average of 8 years after their initial outpatient testing to examine the stability of hypothesized cognitive and psychophysiological vulnerability factors and their relationship to long-term outcome. Assessments of individuals focus on cognitive performance, Assessments of possible environmental factors examine stressful life events, social support, and use of coping strategies.
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