Work rehabilitation in schizophrenia: does cognitive impairment limit improvement?

Cognitive impairments may be an important contributor to disability in schizophrenia and may limit the rate of improvement in work rehabilitation. Thirty-three outpatients with schizophrenia or schizoaffective disorder who participated in a 6-month work rehabilitation program were assessed for symptom severity and administered neuropsychological testing at intake. Their work performance was evaluated biweekly using the Work Behavior Inventory. On each of five domains of work performance, 76 to 91 percent of subjects reached proficiency or improved significantly over 26 weeks. Individual differences in rate of improvement were robustly predicted by neuropsychological variables: Work Habits, r2 = 0.79; Personal Presentation, r2 = 0.73; Cooperativeness, r2 = 0.67; Work Quality, r2 = 0.56; Social Skills, r2 = 0.27; Total, r2 = 0.44. Neuropsychological measures had differential relationships to work domains. Individual differences in improvement were not predicted by symptom measures. These findings link cognitive impairment to disability and suggest that remediating or accommodating such deficits may be necessary for successful rehabilitation.