Bon1.qxd

Gary R. Bond, Ph.D.
Hea-Won Kim, Ph.D. Piper S. Meyer, Ph.D. P. Joseph Gibson, Ph.D., M.P.H.
Sandra Tunis, Ph.D.
Jovier D. Evans, Ph.D.
Paul Lysaker, Ph.D.
Marion L. McCoy, Ph.D.
Jerry Dincin, Ph.D.
Haiyi Xie, Ph.D.
Objective: Second-generation antipsychotics may enhance the rehabilita-
tion of individuals with schizophrenia. The authors hypothesized that
clients receiving second-generation antipsychotics would use vocational
rehabilitation services more effectively and would have better employ-
tutionalization era, many mentalhealth professionals have been ment outcomes than those receiving first-generation antipsychotics.
Methods: Ninety unemployed clients with schizophrenia and related dis-
orders who were beginning a vocational rehabilitation program were fol-
lowed for nine months. Three groups were defined according to the med-
ication in use at study entry: olanzapine (N=39), risperidone (N=27), or
first-generation antipsychotics only (N=24). Participants were inter-
viewed monthly. Results: The olanzapine and risperidone groups did not
differ on any employment outcomes. On most vocational indicators,
clients receiving second-generation agents did not differ from those re-
ceiving first-generation agents. However, at nine months the second-gen-
eration group had a significantly higher rate of participation in vocation-
al training; a trend was found toward a higher rate of paid employment.
All groups showed substantial improvement in employment outcomes af-
ter entering a vocational program. Conclusions: The hypothesis that sec-
ond-generation antipsychotics promote better employment outcomes
than first-generation antipsychotics was not upheld. However, second-
generation agents appear to be associated with increased participation in
vocational rehabilitation. (Psychiatric Services 55:59–66, 2004)
medications in combination with bestpractices in psychiatric rehabilitationlead to greater improvements in reha-bilitation outcomes than does either Dr. Bond and Dr. Evans are affiliated with the department of psychology at Indiana Uni- versity–Purdue University Indianapolis, 402 North Blackford Street, Indianapolis, Indi- ana 46202-3275 (e-mail, gbond@iupui.edu). Dr. Kim is with Indiana University School of Social Work in Indianapolis. Dr. Meyer is with the University of North Carolina Cecil G. Sheps Center for Health Services Research in Chapel Hill. Dr. Gibson is with the Health and Hospital Corporation of Marion County in Indianapolis. Dr. Tunis is with Eli Lilly and Company in Indianapolis. Dr. Lysaker is with Roudebush Veterans AffairsMedical Center in Indianapolis. Dr. McCoy is with Westat in Rockville, Maryland. Dr. Dincin is with Thresholds in Chicago. Dr. Xie is with the New Hampshire-Dartmouth Psychiatric Research Center in Lebanon. PSYCHIATRIC SERVICES ♦ http://ps.psychiatryonline.org ♦ January 2004 Vol. 55 No. 1 est in the role of medications in the re- University institutional review board.
PSYCHIATRIC SERVICES ♦ http://ps.psychiatryonline.org ♦ January 2004 Vol. 55 No. 1 were corroborated by agency records.
ized records and caseworker reports.
total score and five subscales (42).
PSYCHIATRIC SERVICES ♦ http://ps.psychiatryonline.org ♦ January 2004 Vol. 55 No. 1 Characteristics at baseline interview of 90 unemployed persons with schizophrenia enrolled in a vocational rehabilitation pro-gram, by medication group a The Positive and Negative Syndrome Scale; possible scores range from 30 to 210, with higher scores indicating greater symptom severity. For the five PANSS factors, possible score ranges are as follows: positive, –6 to 42; negative, –8 to 56; emotional, –4 to 28; hostility, –4 to 28; cognitive, –7to 49. b Data were missing for three clients in the olanzapine group, two clients in the risperidone group, and two clients in the first-generation group.
c Data were missing for two clients in the olanzapine group and one client in the risperidone group.
d F=17.328, df= 2, 82, p<.001; data were missing for three clients in the olanzapine group and two clients in the risperidone group. Post-hoc compar- isons using Tukey’s least significant difference test indicated significant differences (p<.001) between both second-generation groups and the first-gen-eration group, but not between the olanzapine and risperidone groups.
e χ2=7.86, df=2, p=.020f χ2=6.10, df=2, p=.047g Data were missing for one client in the risperidone group and one client in the first-generation group.
PSYCHIATRIC SERVICES ♦ http://ps.psychiatryonline.org ♦ January 2004 Vol. 55 No. 1 Work outcomes at nine-month follow-up for 90 unemployed persons with schizophrenia enrolled in a vocational rehabilita-tion program, by medication group mission to first paid job(mean±SD weeks)b a Data were missing for one client in the risperidone group and three clients in the first-generation antipsychotics group.
b Data were from 29 clients in the olanzapine group, 17 clients in the risperidone group, and 13 clients in the first-generation antipsychotics group who obtained paid employment during the study period.
risperidone groups, the two groupswere aggregated into a single second-generation group and were comparedwith the first-generation group. The Employment status at nine-month follow-up for 90 unemployed persons with schizophrenia enrolled in a vocational rehabilitation program, by medication package employing random effectslogistic regression to model longitudi- the two groups. Time zero in themodels was set as the date a study PSYCHIATRIC SERVICES ♦ http://ps.psychiatryonline.org ♦ January 2004 Vol. 55 No. 1 were receiving oral medication only.
Discussion
psychiatric rehabilitation services (8).
ation group (t=3.76, df=718, p=.001).
PSYCHIATRIC SERVICES ♦ http://ps.psychiatryonline.org ♦ January 2004 Vol. 55 No. 1 flect the “real world” nature of this Conclusions
Acknowledgments
This study was funded by a grant from Eli McGuire and Marc Lauritano for theirhelp in data analysis. References
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