The persistent vocational disability associated with schizophrenia is an enormous problem for patients, their families, and systems of public financial support. Clinical and demographic variables account for little of the variance in vocational outcome. To address this issue, we are proposing a study design which has not been utilized in previous investigations: a neuropsychological, cognitive liability marker, social skills and MRI studies of patients who have demonstrated good vocational performance contrasted with appropriate poor vocational outcome patients and normal controls. Good vocational performance requires patients to have held paid, competitive employment, for 24 or more hours a week, for at least 75% of the last two years. The contrast of patients differing in vocational outcome should highlight the cognitive functions and social skills which are required for successful occupational functioning, and the brain morphological features are associated with outcome. Pilot data suggest that patients with good and poor vocational outcome differ in neuropsychological performance and in qualitative aspects of brain morphology, while sharing hippocampal volume reduction and impairments on liability markers. Thus, some abnormalities are evident in both groups, while others may be markers of disability. Identification of disability markers could provide an empirical foundation necessary to develop rational treatment approaches to vocational disability in schizophrenia. The study of good outcome patients also offers the opportunity to examine abnormalities which are associated with the illness, independent of functional disability. Abnormalities present in both good and poor outcome groups are arguably fundamental features of the illness.
| Dickinson, Dwight; Bellack, Alan S; Gold, James M (2007) Social/communication skills, cognition, and vocational functioning in schizophrenia. Schizophr Bull 33:1213-20 |
| Wilk, Christopher M; Gold, James M; McMahon, Robert P et al. (2005) No, it is not possible to be schizophrenic yet neuropsychologically normal. Neuropsychology 19:778-86 |
| Gold, James M; Poet, Michael S; Wilk, Christopher M et al. (2004) The family pictures test as a measure of impaired feature binding in schizophrenia. J Clin Exp Neuropsychol 26:511-20 |
| Dickinson, Dwight; Iannone, Virginia N; Wilk, Christopher M et al. (2004) General and specific cognitive deficits in schizophrenia. Biol Psychiatry 55:826-33 |
| Dickinson, Dwight; Iannone, Virginia N; Gold, James M (2002) Factor structure of the Wechsler Adult Intelligence Scale-III in schizophrenia. Assessment 9:171-80 |
| Gold, J M; Queern, C; Iannone, V N et al. (1999) Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia I: sensitivity, reliability, and validity. Am J Psychiatry 156:1944-50 |
