The Developmental Processes in Schizophrenic Disorders project involves an ongoing series of longitudinal studies of the psychopathology and treatment of individuals with a recent onset of schizophrenia. The proposed new protocol focuses on improving the efficacy of interventions targeting work and school functioning during the early stage of schizophrenia and examining the mediators of their effects. Effective interventions for individuals in the early stage of schizophrenia are critical for preventing chronic patterns of disability and are therefore of particular public health significance. The new protocol aims to build upon the substantial gains in work and school re-entry that were achieved with the current treatment protocol using Individual Placement and Support and Workplace Fundamental Modules. Based on evidence that neurocognitive deficits and medication non-adherence are key determinants of impaired work performance, the new protocol will test whether cognitive remediation procedures, aimed at improving neurocogriition, and injectable, long-acting risperidone, aimed at increasing medication adherence, can increase work/school performance. Hypothesized mechanisms through which these treatments may influence functional outcome will be evaluated. To clarify the mediators and moderators of the impact of cognitive remediation on work/school functioning, aspects of social cognition, coping skills, learning of work skills, awareness of illness, and motivation will be examined. The study will determine whether injectable, long-acting risperidone improves medication adherence, clinical course, and work/school functioning as compared to oral risperidone. Potential predictors of response to these treatments will be evaluated.
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