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An RCT Evaluating the Effects of Skills Training and Medication Type on Work Outcomes Among Patients With Schizophrenia.
Psychiatr Serv. 2017 03 01; 68(3):271-277.PS

Abstract

OBJECTIVE

Although supported employment increases job acquisition for people with serious mental illness, data on participants' job tenure have been variable. This study evaluated the effects of a standardized work skills training program (the Workplace Fundamentals Module [WPFM]) on job tenure and other work outcomes among individuals receiving individual placement and support (IPS). The effects of two atypical antipsychotic medications on side effects were also tested. The primary hypothesis tested was that participants in IPS plus WPFM would have increased job tenure compared with those enrolled in IPS only, and the secondary hypothesis was that different antipsychotic medications would yield unique side effects.

METHODS

A 2×2 randomized controlled trial compared work outcomes, including job tenure, of participants receiving IPS with or without WPFM for up to two years after obtaining a job. Participants were also randomly assigned to olanzapine or risperidone. Measures of work outcomes, clinical status, and medication side effects were collected.

RESULTS

Among 107 participants, 63% obtained at least one job. WPFM did not increase job tenure (51.53 and 41.37 total weeks worked for IPS only and IPS plus WPFM, respectively) or affect other work outcomes. Participants on olanzapine experienced increased body mass index, whereas those on risperidone lost weight, but medications did not differentially affect clinical or job outcomes.

CONCLUSIONS

Clinic-based skills training did not improve work outcomes accruing from IPS. Risperidone, compared with olanzapine, may reduce body mass but has no differential effect on other work or clinical outcomes.

Authors+Show Affiliations

Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail: sglynn@ucla.edu). Dr. Noordsy is with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Mr. O'Keefe is a graduate student at Southern New Hampshire University, Manchester. Ms. Becker and Dr. Drake are with the Rockville Institute, Westat, Lebanon, New Hampshire. Dr. Sugar is with the Department of Biostatistics, Fielding School of Public Health, and with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Dr. Noordsy, Mr. O'Keefe, Ms. Becker, and Dr. Drake were with the Department of Psychiatry, and Ms. Becker and Dr. Drake were also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth University, Hanover, at the time of this research.Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail: sglynn@ucla.edu). Dr. Noordsy is with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Mr. O'Keefe is a graduate student at Southern New Hampshire University, Manchester. Ms. Becker and Dr. Drake are with the Rockville Institute, Westat, Lebanon, New Hampshire. Dr. Sugar is with the Department of Biostatistics, Fielding School of Public Health, and with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Dr. Noordsy, Mr. O'Keefe, Ms. Becker, and Dr. Drake were with the Department of Psychiatry, and Ms. Becker and Dr. Drake were also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth University, Hanover, at the time of this research.Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail: sglynn@ucla.edu). Dr. Noordsy is with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Mr. O'Keefe is a graduate student at Southern New Hampshire University, Manchester. Ms. Becker and Dr. Drake are with the Rockville Institute, Westat, Lebanon, New Hampshire. Dr. Sugar is with the Department of Biostatistics, Fielding School of Public Health, and with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Dr. Noordsy, Mr. O'Keefe, Ms. Becker, and Dr. Drake were with the Department of Psychiatry, and Ms. Becker and Dr. Drake were also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth University, Hanover, at the time of this research.Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail: sglynn@ucla.edu). Dr. Noordsy is with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Mr. O'Keefe is a graduate student at Southern New Hampshire University, Manchester. Ms. Becker and Dr. Drake are with the Rockville Institute, Westat, Lebanon, New Hampshire. Dr. Sugar is with the Department of Biostatistics, Fielding School of Public Health, and with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Dr. Noordsy, Mr. O'Keefe, Ms. Becker, and Dr. Drake were with the Department of Psychiatry, and Ms. Becker and Dr. Drake were also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth University, Hanover, at the time of this research.Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail: sglynn@ucla.edu). Dr. Noordsy is with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Mr. O'Keefe is a graduate student at Southern New Hampshire University, Manchester. Ms. Becker and Dr. Drake are with the Rockville Institute, Westat, Lebanon, New Hampshire. Dr. Sugar is with the Department of Biostatistics, Fielding School of Public Health, and with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Dr. Noordsy, Mr. O'Keefe, Ms. Becker, and Dr. Drake were with the Department of Psychiatry, and Ms. Becker and Dr. Drake were also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth University, Hanover, at the time of this research.Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail: sglynn@ucla.edu). Dr. Noordsy is with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Mr. O'Keefe is a graduate student at Southern New Hampshire University, Manchester. Ms. Becker and Dr. Drake are with the Rockville Institute, Westat, Lebanon, New Hampshire. Dr. Sugar is with the Department of Biostatistics, Fielding School of Public Health, and with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Dr. Noordsy, Mr. O'Keefe, Ms. Becker, and Dr. Drake were with the Department of Psychiatry, and Ms. Becker and Dr. Drake were also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth University, Hanover, at the time of this research.Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail: sglynn@ucla.edu). Dr. Noordsy is with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Mr. O'Keefe is a graduate student at Southern New Hampshire University, Manchester. Ms. Becker and Dr. Drake are with the Rockville Institute, Westat, Lebanon, New Hampshire. Dr. Sugar is with the Department of Biostatistics, Fielding School of Public Health, and with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Dr. Noordsy, Mr. O'Keefe, Ms. Becker, and Dr. Drake were with the Department of Psychiatry, and Ms. Becker and Dr. Drake were also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth University, Hanover, at the time of this research.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27799019

Citation

Glynn, Shirley M., et al. "An RCT Evaluating the Effects of Skills Training and Medication Type On Work Outcomes Among Patients With Schizophrenia." Psychiatric Services (Washington, D.C.), vol. 68, no. 3, 2017, pp. 271-277.
Glynn SM, Marder SR, Noordsy DL, et al. An RCT Evaluating the Effects of Skills Training and Medication Type on Work Outcomes Among Patients With Schizophrenia. Psychiatr Serv. 2017;68(3):271-277.
Glynn, S. M., Marder, S. R., Noordsy, D. L., O'Keefe, C., Becker, D. R., Drake, R. E., & Sugar, C. A. (2017). An RCT Evaluating the Effects of Skills Training and Medication Type on Work Outcomes Among Patients With Schizophrenia. Psychiatric Services (Washington, D.C.), 68(3), 271-277. https://doi.org/10.1176/appi.ps.201500171
Glynn SM, et al. An RCT Evaluating the Effects of Skills Training and Medication Type On Work Outcomes Among Patients With Schizophrenia. Psychiatr Serv. 2017 03 1;68(3):271-277. PubMed PMID: 27799019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An RCT Evaluating the Effects of Skills Training and Medication Type on Work Outcomes Among Patients With Schizophrenia. AU - Glynn,Shirley M, AU - Marder,Stephen R, AU - Noordsy,Douglas L, AU - O'Keefe,Christopher, AU - Becker,Deborah R, AU - Drake,Robert E, AU - Sugar,Catherine A, Y1 - 2016/11/01/ PY - 2016/11/2/pubmed PY - 2018/2/23/medline PY - 2016/11/2/entrez KW - Schizophrenia, Drugs &amp KW - psychotherapy, Outcome studies, Work-related disabilities SP - 271 EP - 277 JF - Psychiatric services (Washington, D.C.) JO - Psychiatr Serv VL - 68 IS - 3 N2 - OBJECTIVE: Although supported employment increases job acquisition for people with serious mental illness, data on participants' job tenure have been variable. This study evaluated the effects of a standardized work skills training program (the Workplace Fundamentals Module [WPFM]) on job tenure and other work outcomes among individuals receiving individual placement and support (IPS). The effects of two atypical antipsychotic medications on side effects were also tested. The primary hypothesis tested was that participants in IPS plus WPFM would have increased job tenure compared with those enrolled in IPS only, and the secondary hypothesis was that different antipsychotic medications would yield unique side effects. METHODS: A 2×2 randomized controlled trial compared work outcomes, including job tenure, of participants receiving IPS with or without WPFM for up to two years after obtaining a job. Participants were also randomly assigned to olanzapine or risperidone. Measures of work outcomes, clinical status, and medication side effects were collected. RESULTS: Among 107 participants, 63% obtained at least one job. WPFM did not increase job tenure (51.53 and 41.37 total weeks worked for IPS only and IPS plus WPFM, respectively) or affect other work outcomes. Participants on olanzapine experienced increased body mass index, whereas those on risperidone lost weight, but medications did not differentially affect clinical or job outcomes. CONCLUSIONS: Clinic-based skills training did not improve work outcomes accruing from IPS. Risperidone, compared with olanzapine, may reduce body mass but has no differential effect on other work or clinical outcomes. SN - 1557-9700 UR - https://www.unboundmedicine.com/medline/citation/27799019/An_RCT_Evaluating_the_Effects_of_Skills_Training_and_Medication_Type_on_Work_Outcomes_Among_Patients_With_Schizophrenia_ L2 - https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201500171?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -