Difficulty in living independently in a community is the most costly aspect of persistent mental illness. What causes this disability is largely unknown. Rehabilitation programs and psychopharmacological treatments have been only minimally successful in improving independent functioning. While neuropsychological deficits, such as impairments in attention, memory, and executive functioning are known to be prevalent in persistent mental illness, their contribution to independent functioning has been barely explored. Neuropsychological deficits may be a significant contributor to impairment in independent functioning and the associated need for support services. The proposed study is a naturalistic follow-up of 200 persons with schizo-phrenia between the ages of 18 and 45, recently admitted to a private hospital with an acute exacerbation of illness. Subjects will be assessed over 1.5 years on a set of neurobehavioral, symptom, and life functioning measures as well as utilization of mental health services. Neurobehavioral measures include a neuropsychological battery and ratings of psychopathology. Life functioning measures include ratings of independent functioning, support and performance in work, educational, residential, and social environments. Mental health services include all clinical, vocational, and residential services. The following hypotheses will be tested: (1) Neuropsychological deficits, independent of residual symptomatology, are associated with dis-abilities in independent functioning and quality of life in the domains of work, residential, education, and socialization; (2) The course of neuro-psychological deficits during the period of recovery following an acute exacerbation of psychosis is associated with the course of reintegration into life roles in the community. A secondary hypothesis is that neuropsycho-logical deficits are associated, independently of symptom severity, with utilization of both clinical treatment and rehabilitation services.
