Maintaining functional working memory through job activities: A study among patients with schizophrenia enrolled in a supported employment program

Abstract

BACKGROUND:

Employment is crucial in rehabilitation of patients with schizophrenia. It may have positive effects on cognitive function, including working memory.

OBJECTIVE:

The objective of this study was to look for evidence to confirm continuous job activities could maintain functional working memory in patients with schizophrenia.

METHODS:

This was a cross-sectional study involving patients with schizophrenia enrolled in supported employment (SE) program. Informed consent was obtained. Socio-demographic, employment, and clinical data were acquired from interview and clinical notes. Mini International Neuropsychiatric Inventory (M.I.N.I) was used to confirm the diagnosis of schizophrenia. Working memory was evaluated using Weschler Memory Scale Third Edition -Letter-Number Span and Spatial Span.

RESULTS:

118 patients were recruited with a mean age of 43.76 years old (SD = 8.96). Most were male, Malays, Muslims, single, and received at least secondary education. There was a significant association between working memory and employment outcome (χ² = 20.835, p < .001), and past work history (χ² = 10.077, p = 0.002). Multiple logistic regression indicated that the employment outcome (adjusted OR: 12.50; 95% CI: 2.55–61.21; p = 0.002) and past work history (adjusted OR: 3.36; 95% CI: 1.05–10.70; p = 0.041) were significant predictors of working memory among patients with schizophrenia in SE program.

CONCLUSION:

This study indicated that continuous job activities could maintain functional working memory in patients with schizophrenia.

Keywords

Schizophrenia supported employment working memory cognitive function psychosocial rehabilitation

Get full access to this article

View all access options for this article.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.

August,

S. M.

, Kiwanuka,

J. N.

, McMahon,

R. P.

, Gold,

J. M.

(2012) The MATRICS Consensus Cognitive Battery (MCCB): Clinical and cognitive correlates. Schizophrenia Research. 134(1), 76–82. https://doi.org/10.1016/j.schres.2011.10.015.

Aziz,

A. A.

, Salina,

A. A.

, Abdul Kadir

A. B.

, Badiah,

, Cheah,

Y. C.

, Nor Hayati

, Ruzanna,

Z. Z.

, Sharifah Suziah

S. M.

, Chee,

K. Y.

(2008) The National Mental Health Registry (NMHR). The Medical Journal of Malaysia. 63(Suppl C), 15–17. .

Baddeley,

(1992) Working memory. Science. 255(5044), 556LP–559. https://doi.org/10.1126/science.1736359.

Bell,

, Bryson,

, Greig,

, Corcoran,

, Wexler,

B. E.

(2001) Neurocognitive enhancement therapy with work therapy: Effects on neuropsychological test performance.. Archives of General Psychiatry. 58(8), 763–768. https://doi.org/10.1001/archpsyc.58.8.763.

Bell,

, Fiszdon,

, Greig,

, Wexler,

, Bryson,

(2007) Neurocognitive enhancement therapy with work therapy in schizophrenia: 6-Month follow-up of neuropsychological performance.. Journal of Rehabilitation Research and Development. 44(5), 761–770. https://doi.org/10.1682/JRRD.2007.02.0032.

Bond,

G. R.

, Drake,

R. E.

, Becker,

D. R.

(2008) An update on randomized controlled trials of evidence-based supported employment.. Psychiatric Rehabilitation Journal. 31(4), 280–290. https://doi.org/10.2975/31.4.2008.280.290 .

Charzyńska,

, Kucharska,

, Mortimer,

(2015) Does employment promote the process of recovery from schizophrenia? A review of the existing evidence. International Journal of Occupational Medicine and Environmental Health. 28(3), 407–418. https://doi.org/10.13075/ijomeh.1896.00341.

Federal Register (2001) State Vocational Rehabilitation Services Program: Final Rules.: U.S. Government Printing Office. 66(11), 4389.

10.

Forbes,

N. F.

, Carrick,

L. A.

, McIntosh,

A. M.

, Lawrie,

S. M.

(2009) Working memory in schizophrenia: A meta-analysis. In Psychological Medicine. 39(6), 889–905. https://doi.org/10.1017/S0033291708004558.

11.

Frederick,

D. E.

, VanderWeele,

T. J.

(2019) Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support. PLoS ONE. 14(2), 1–26. https://doi.org/10.1371/journal.pone.0212208.

12.

Green,

M. F.

(2006) Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. The Journal of Clinical Psychiatry. 67(10), e12.

13.

Harvey,

P. D.

, Ph,

, Keefe,

R. S. E.

(2001) Reviews and overviews schizophrenia following novel antipsychotic treatment. Psychiatry: Interpersonal and Biological Processes, February, 176-184.

14.

Hsu,

W. Y.

, Lane,

H. Y.

, Lin,

C. H.

(2018) Medications used for cognitive enhancement in patients with schizophrenia, bipolar disorder, Alzheimer’ disease, and Parkinson's disease. Frontiers in Psychiatry.https://doi.org/10.3389/fpsyt.2018.00091

15.

Impey,

, Baddeley,

, Nelson,

, Labelle,

, Knott,

(2017) Effects of transcranial direct current stimulation on the auditory mismatch negativity response and working memory performance in schizophrenia: A pilot study. Journal of Neural Transmission (Vienna, Austria: 1996). 124(11), 1489–1501.https://doi.org/10.1007/s00702-017-1783-y.

16.

Jiang,

, Guo,

, Xing,

, He,

, Peng,

, Du,

, McClure,

M. A.

, Mu,

(2019) Effects of high-frequency transcranial magnetic stimulation for cognitive deficit in schizophrenia: A meta-analysis. Frontiers in Psychiatry. 10(MAR), 1–11. https://doi.org/10.3389/fpsyt.2019.00135.

17.

Keefe,

R. S. E.

, Fenton,

W. S.

(2007) How should DSM-V criteria for schizophrenia include cognitive impairment?Schizophrenia Bulletin. 33(4), 912–920. https://doi.org/10.1093/schbul/sbm046.

18.

Kern,

R. S.

, Nuechterlein,

K. H.

, Green,

M. F.

, Baade,

L. E.

, Fenton,

W. S.

, Gold,

J. M.

, Keefe,

R. S. E.

, Mesholam-Gately,

, Mintz,

, Seidman,

L. J.

, Stover,

, Marder,

S. R.

(2008) The MATRICS Consensus Cognitive Battery, part 2: Co-norming and standardization. American Journal of Psychiatry. 165(2), 214–220. https://doi.org/10.1176/appi.aj2007.07010043.

19.

Kinoshita,

, Ta,

, Kinoshita,

, Honyashiki,

, Im,

, Marshall,

, Gr,

, Huxley,

, Kinoshita,

, Ta,

, Kinoshita,

, Honyashiki,

, Im,

, Marshall,

, Gr,

, Huxley,

, Amano,

, Kingdon,

(2013) Schizophrenia can and should be renamed. BMJ. 2007;334, 221–2. https://doi.org/10.1002/14651858.CD008297.pub2.www.cochranelibrary.com.

20.

Lawlor-Savage,

, Goghari,

V. M.

(2014) Working memory training in schizophrenia and healthy populations. Behavioral Sciences. 4(3), 301–319. https://doi.org/10.3390/bs4030301.

21.

Lystad,

J. U.

, Falkum,

, Mohn,

, Haaland,

V. Ø.

, Bull,

, Evensen,

, Rund,

B. R.

, Ueland,

(2014) The MATRICS Consensus Cognitive Battery (MCCB): Performance and functional correlates. Psychiatry Research. 220(3), 1094–1101. https://doi.org/10.1016/j.psychres.2014.08.060.

22.

Marshall,

, Goldberg,

R. W.

, Braude,

, Dougherty,

R. H.

, Daniels,

A. S.

, Ghose,

S. S.

, George,

, Delphin-Rittmon,

M. E.

(2014) Supported employment: Assessing the evidence. Psychiatric Services. 65(1), 16–23. https://doi.org/10.1176/appi.ps.201300262.

23.

McGurk,

S. R.

, Meltzer,

H. Y.

(2000) The role of cognition in vocational functioning in schizophrenia. Schizophrenia Research. 45(3), 175–184. https://doi.org/10.1016/s0920-9964(99)00198-x.

24.

McGurk,

S. R.

, Drake,

R. E.

, Xie,

, Riley,

, Milfort,

, Hale,

T. W.

, Frey,

(2018) Cognitive predictors of work among social security disability insurance beneficiaries with psychiatric disorders enrolled in IPS supported employment. Schizophrenia Bulletin. 44(1), 32–37. https://doi.org/10.1093/schbul/sbx115.

25.

Medical Development Division Ministry of Health Malaysia (2011) Psychiatric and mental health services operational policy. 124. https://www.moh.gov.my/images/gallery/Polisi/PSYCHIATRYOPERATIONALPOLICY.pdf.

26.

Metcalfe,

J. D.

, Riley,

, McGurk,

, Hale,

, Drake,

R. E.

, Bond,

G. R.

(2018) Comparing predictors of employment in Individual Placement and Support: A longitudinal analysis. Psychiatry Research. 264, 85–90. https://doi.org/https://doi.org/10.1016/j.psychres.2018.03.050.

27.

Midin,

, Razali,

, ZamZam,

, Fernandez,

, Hum,

L. C.

, Shah,

S. A.

, Radzi,

R. S. M.

, Zakaria,

, Sinniah,

(2011) Clinical and cognitive correlates of employment among patients with schizophrenia: A cross-sectional study in Malaysia. International Journal of Mental Health Systems. 5(1), 14. https://doi.org/10.1186/1752-4458-5-14.

28.

Normala,

, Abdul Hamid

A. R.

, Shamsul Azhar

(2009) Neuro-cognitive performance in patients with schizophrenia: A cross-sectional study in a psychiatric clinic of a University Hospital. Journal of Medicine and Health Sciences. 5(1), 21–30.

29.

Nuechterlein,

K. H.

, Green,

M. F.

, Kern,

R. S.

, Baade,

L. E.

, Barch,

D. M.

, Cohen,

J. D.

, Essock,

, Fenton,

W. S.

, Frese,

F. J.

, Gold,

J. M.

, Goldberg,

, Heaton,

R. K.

, Keefe,

R. S. E.

, Kraemer,

, Mesholam-Gately,

, Seidman,

L. J.

, Stover,

, Weinberger,

D. R.

, Young,

A. S.

, Marder

S. R.

(2008) The MATRICS consensus cognitive battery, part 1: Test selection, reliability, and validity. American Journal of Psychiatry. 165(2), 203–213. https://doi.org/10.1176/appi.ajp.2007.07010042.

30.

Nuechterlein,

K. H.

, Subotnik,

K. L.

, Green,

M. F.

, Ventura,

, Asarnow,

R. F.

, Gitlin,

M. J.

, Yee,

C. M.

, Gretchen-Doorly,

, Mintz,

(2011) Neurocognitive predictors of work outcome in recent-onset schizophrenia.. Schizophrenia Bulletin. 37(SUPPL. 2), 33–40. https://doi.org/10.1093/schbul/sbr084.

31.

Rajji,

T. K.

, Ismail,

, Mulsant,

B. H.

(2009) Age at onset and cognition in schizophrenia: Meta-analysis.. British Journal of Psychiatry. 195(4), 286–293. https://doi.org/10.1192/bjp.bp.108.060723.

32.

Reichenberg,

(2010) The assessment of neuropsychological functioning in schizophrenia. Dialogues in Clinical Neuroscience. 12(3), 383–392. https://doi.org/10.31887/DCNS.2010.12.3/areichenberg.

33.

Schwippel,

, Papazova,

, Strube,

, Fallgatter,

A. J.

, Hasan,

, Plewnia,

(2018) Beneficial effects of anodal transcranial direct current stimulation (tDCS) on spatial working memory in patients with schizophrenia. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology. 28(12), 1339–1350. https://doi.org/10.1016/j.euroneuro.2018.09.009.

34.

Sheehan,

D. V.

, Lecrubier,

, Sheehan,

K. H.

, Amorim,

, Janavs,

, Weiller,

, Hergueta,

, Baker,

, Dunbar,

G. C.

(1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry. 59(SUPPL. 20), 22–33. https://doi.org/10.1016/S0924-9338(99)80239-9.

35.

Subramaniam,

, Luks,

T. L.

, Garrett,

, Chung,

, Fisher,

, Nagarajan,

, Vinogradov,

(2014) Intensive cognitive training in schizophrenia enhances working memory and associated prefrontal cortical efficiency in a manner that drives long-term functional gains. NeuroImage. 99, 281–292. https://doi.org/10.1016/j.neuroimage.2014.05.057.

36.

Wexler,

B. E.

, Bell,

M. D.

(2005) Cognitive remediation and vocational rehabilitation for schizophrenia. Schizophrenia Bulletin. 31(4), 931–941. https://doi.org/10.1093/schbul/sbi038.