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Occupational functioning in early non-affective psychosis: the role of attributional biases, symptoms and executive functioning

Published online by Cambridge University Press:  19 March 2013

M. Fornells-Ambrojo*
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
T. Craig
Affiliation:
Health Services Research Department, Institute of Psychiatry, King's College London, London, UK
P. Garety
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
*
*Address for correspondence: Dr M. Fornells-Ambrojo, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK. (Email: [email protected])

Abstract

Aims.

Occupational functioning is severely impaired in people with psychosis. Social cognition has recently been found to be a stronger predictor of functioning than neurocognition. This study is the first to investigate if externalizing attributional biases that are typically associated with psychosis play a role in the vocational pathways of people with early psychosis.

Methods.

A cross-sectional design was used. Fifty participants with early psychosis were recruited from a cohort of 144 participants of the Lambeth Early Onset randomized control trial at 18-month follow-up. Information on occupational functioning was obtained using case notes and interview. Severity of symptoms was assessed and participants completed measures on attributional style and executive functioning.

Results.

Although executive functioning and positive symptoms were associated with poor occupational functioning, an externalizing attributional style for failures and reduced engagement in occupational activities during the previous 18 months emerged as the only predictors of poor occupational functioning at 18-month follow-up.

Conclusions.

An externalizing attributional bias is associated with poor occupational functioning. Further research is needed to investigate the direction of this relationship and whether attributional biases mediate the impact of symptoms and cognitive impairment on functioning.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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References

Addington, D, Addington, J, Maticka-Tyndale, E (1993). Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry 163, 3944.Google Scholar
Addington, J, Saeedi, H, Addington, D (2006 a). Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. British Journal of Psychiatry 189, 373378.CrossRefGoogle ScholarPubMed
Addington, J, Saeedi, H, Addington, D (2006 b). Facial affect recognition: a mediator between cognitive and social functioning in psychosis? Schizophrenia Research 85, 142150.CrossRefGoogle ScholarPubMed
Aitchison, KJ, Meehan, K, Murray, RM (1999). First Episode Psychosis. Martin Dunitz, London, UKGoogle Scholar
Allott, K, Liu, P, Proffitt, TM, Killackey, E (2011). Cognition at illness onset as a predictor of later functional outcome in early psychosis: Systematic review and methodological critique. Schizophrenia Research 125, 221235.Google Scholar
Baron-Cohen, S (1995). Mind Blindness: An Essay on Autism and Theory of Mind. MIT Press/Bradford Books: Boston.CrossRefGoogle Scholar
Baumgartner, JN, Susser, E (2012). Social integration in global mental health: what is it and how can it be measured? Epidemiology and Psychiatric Sciences. doi: http://dx.doi.org/10.1017/S2045796012000595. Published online: 26 October 2012.Google Scholar
Bebbington, PE, Craig, T, Garety, P, Fowler, D, Dunn, G, Colbert, S, Fornells-Ambrojo, M, Kuipers, E (2006). Remission and relapse in psychosis: operational definitions based on case-note data. Psychological Medicine 36, 15511562.Google Scholar
Bentall, RP, Corcoran, R, Howard, R, Blackwood, N, Kinderman, P (2001). Persecutory delusions: a review and theoretical integration. Clinical Psychological Review 21, 11431192.Google Scholar
Brüne, M (2005). ‘Theory of Mind’ in schizophrenia: a review of the literature. Schizoprhenia Bulletin 31, 2142.CrossRefGoogle ScholarPubMed
Brüne, M, Brüne-Cohrs, U (2006). Theory of mind – evolution, ontogeny, brain mechanisms and psychopathology. Neuroscience and Biobehavioural Reviews 30, 437455.CrossRefGoogle ScholarPubMed
Burns, JK (2011). The mental health gap in South Africa: a human rights issue. Equal Rights Review 6, 99114.Google Scholar
Burns, JK (2012). Social integration and human rights: a view from a low and middle income context. Epidemiology and Psychiatric Sciences. doi: http://dx.doi.org/10.1017/S2045796012000595. Published online: 26 October 2012.Google ScholarPubMed
Combs, DR, Penn, DL, Wicher, M, Waldheter, E (2007). The Ambiguous Intentions Hostility Questionnaire (AIHQ): a new measure for evaluating hostile social-cognitive biases in paranoia. Cognitive Neuropsychiatry 12, 128143.CrossRefGoogle ScholarPubMed
Combs, DR, Penn, DL, Michael, CO, Basso, MR, Wiedeman, R, Siebenmorgan, M, Tiegreen, JA, Chapman, D (2009). Perceptions of hostility by persons with and without persecutory delusions. Cognitive Neuropsychiatry 14, 3052.Google Scholar
Craig, T, Garety, PA, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M (2004). The Lambeth Ealy Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 10671070.Google Scholar
Davidson, L (2012). Living recovery. Epidemiology and Psychiatric Sciences 21, 365366.CrossRefGoogle ScholarPubMed
Del Piccolo, L, Goss, C (2012). People centred care: new research needs and methods in doctor–patient communication. Challenges in mental health. Epidemiology and Psychiatric Sciences 21, 145149.CrossRefGoogle ScholarPubMed
Department of Health (2001). Compendium of clinical and social indicators. London: Department of HealthGoogle Scholar
Department of Work and Pensions (2009). Health Work Wellbeing. Retrieved 31 January 2013 from http://www.dwp.gov.uk/health-work-and-well-being/.Google Scholar
Edwards, J, McGorry, PD (2002). (eds). Implementing Early Intervention in Psychosis. A guide to establishing early psychosis services. London. Martin DunitzCrossRefGoogle Scholar
EPPIC (1997). The early psychosis training pack. Cheshire, UK: Gardiner-Caldwell Communications Ltd.Google Scholar
Fear, CF, Sharp, HM, Healy, D (1996). Cognitive processes in delusional disorders. British Journal of Psychiatry 168, 6167.CrossRefGoogle ScholarPubMed
Fett, AK, Viechtbauer, W, Dominguez, M, Penn, DL, van Os, J, Krabbendam, L (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience and Biobehavioral Reviews 35, 573588.CrossRefGoogle ScholarPubMed
Fisher, D (1994). Health care reform based on an empowerment model of recovery by people with psychiatric disabilities. Hospital and Community Psychiatry 45, 913915.Google Scholar
Fisher, HL, Schreier, A, Zammit, S, Maughan, B, Munafò, MR, Lewis, G, Wolke, D (2012). Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin doi: 10.1093/schbul/sbs088.Google Scholar
Schizophr Bull (2012). doi: 10.1093/schbul/sbs088. Published online: September 1, 2012Google Scholar
Fornells-Ambrojo, M, Garety, PA (2009 a). Understanding attributional biases, emotions and self-esteem in poor me paranoia: Findings from an early psychosis sample. British Journal of Clinical Psychology 48, 141162.CrossRefGoogle ScholarPubMed
Fornells-Ambrojo, M, Garety, P (2009 b). Attributional biases in paranoia: the development and validation of the Achievement and Relationships Attributions Task (ARAT). Cognitive Neuropsychiatry 14, 87109.CrossRefGoogle ScholarPubMed
Fowler, D, Garety, P, Kuipers, E (1995). Cognitive Behaviour Therapy for People with Psychosis. Wiley: East Sussex.Google Scholar
Fowler, D, Hodgekins, J, Painter, M (2009). Cognitive behaviour therapy for improving social recovery in psychosis: a report from the ISREP MRC Trial Platform study (Improving Social Recovery in Early Psychosis). Psychological Medicine 39, 110.Google Scholar
Garety, PA, Craig, T, Dunn, G, Fornells-Ambrojo, M, Colbert, S, Rahaman, N, Reed, J, Power, P (2006). Specialised care for early psychosis: symptoms, social functioning and patient satisfaction. British Journal of Psychiatry 188, 3745.CrossRefGoogle ScholarPubMed
Goss, C, Moretti, F, Mazzi, MA, Del Piccolo, L, Rimondini, M, Zimmermann, C (2008). Involving patients in decisions during psychiatric consultations. British Journal of Psychiatry 193, 416421.CrossRefGoogle ScholarPubMed
Green, MF, Kern, RS, Braff, DL, Mint, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119136.Google Scholar
Harrow, M, Hansford, BG, Astrachan-Fletcher, EB (2009). Locus of control: Relation to schizophrenia, to recovery, and to depression and psychosis. A 15-year longitudinal study. Psychiatry Research 168, 186192.Google Scholar
Heaton, RK (1981). Wisconsin Card Sorting Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Hodgekins, J, Fowler, D (2010). CBT and recovery from psychosis in the ISREP trial: mediating effects of hope and positive beliefs on activity. Psychiatric Services 61, 321324.CrossRefGoogle ScholarPubMed
Hoffmann, H, Kupper, Z, Kunz, B (2000). Hopelessness and its impact on rehabilitation outcome in schizophrenia – an exploratory study. Schizophrenia Research 43, 147158.CrossRefGoogle ScholarPubMed
Hoffmann, H, Kupper, Z, Zbinden, M, Hirsbrunner, HP (2003). Predicting vocational functioning and outcome in schizophrenia outpatients attending a vocational rehabilitation program. Social Psychiatry and Psychiatric Epidemiology 38, 7682.Google Scholar
Janssen, I, Versmissen, D, Campo, JA, Myin-Germeys, JV, van Os, J, Krabbendam, L (2006). Attribution style and psychosis: evidence for an externalizing bias in patients but not in individuals at high risk. Psychological Medicine 36, 771778.CrossRefGoogle ScholarPubMed
Jolley, S, Garety, P, Bebbington, P, Dunn, G, Freeman, D, Kuipers, E, Fowler, D, Hemsley, D (2006). Attributional style in psychosis-The role of affect and belief type. Behavioural Research and Therapy 44, 15971607.CrossRefGoogle ScholarPubMed
Kay, SR, Flszbein, A, Opfer, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophrenia Bulletin 13, 261276.CrossRefGoogle ScholarPubMed
Kinderman, P, Dunbar, R, Bentall, RP (1998). Theory-of-mind deficits and causal attributions. British Journal of Psychology, 89, 191209.CrossRefGoogle Scholar
Kinderman, P, Benn, A (2001). Attributional therapy for hallucinations and paranoia. In A casebook of cognitive therapy for psychosis (ed. Morrison, AT), pp. 197216. Psychology Press: LondonGoogle Scholar
Kongs, SK, Thompson, L, Iverson, GL, Heaton, RK (2000). Wisconsin Card-Sorting Test-64 Card Version Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Lakeman, R, McGowan, P, MacGabhann, L, Parkinson, M, Redmond, M, Sibitz, I, Stevenson, C, Walsh, J (2012). A qualitative study exploring experiences of discrimination associated with mental health problems in Ireland. Epidemiology and Psychiatric Sciences 21, 271279.CrossRefGoogle ScholarPubMed
Leff, J, Warner, R (2006). Social Inclusion of People with Mental Illness. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Little, K, Henderson, C, Brohan, E, Thornicroft, G (2011). Employers’ attitudes to people with mental health problems in the workplace in Britain: changes between 2006 and 2009. Epidemiology and Psychiatric Sciences 20, 7381.CrossRefGoogle ScholarPubMed
Lloyd-Evans, B, Marwaha, S, Burns, T, Secker, J, Latimer, E, Blizard, R, Killaspy, H, Totman, J, Tanskanen, S, Johnson, S (2012). The nature and correlates of paid and unpaid work among service users of London Community Mental Health Teams. Epidemiology and Psychiatric Sciences. doi: http://dx.doi.org/10.1017/S2045796012000534. Published online: 17 October 2012.Google ScholarPubMed
Mancuso, F, Horan, WP, Kern, RS, Green, MF (2011). Social cognition in psychosis: multidimensional structure, clinical correlates, and relationship with functional outcome. Schizophrenia Research 125, 143151.CrossRefGoogle ScholarPubMed
Marwaha, S, Johnson, S (2004). Schizophrenia and employment: a review. Social Psychiatry and Psychiatric Epidemiology 39, 337349.Google Scholar
Mueser, KT, Meyer, P, Penn, DL, Clancy, R, Clancy, DM, Salyers, MP (1997). The illness management and recovery program: rationale, development, and preliminary findings. Schizophrenia Bulletin (Suppl. 1), S32S43.Google Scholar
O'Flynn, D, Craig, T (2001). Which way to work? Occupations, vocations and opportunities for mental health service user. Journal of Mental Health 10, 14.Google Scholar
Parsons, T (1951). The Social System. Free Press: New York.Google Scholar
Randall, F, Corcoran, R, Day, JC, Bentall, RP (2003). Attention, theory of mind, and causal attributions in people with persecutory delusions: A preliminary investigation. Cognitive Neuropsychiatry 8, 287294.CrossRefGoogle ScholarPubMed
Rinaldi, M, Killackey, E, Smith, J, Sheppherd, G, Singh, SP, Craig, T (2010). First episode of psychosis and employment: A review. International Review of Psychiatry 22, 148162.Google Scholar
Robinson, LJ, Kester, DB, Saykin, AJ, Kaplan, EF, Gur, RC (1991). Comparison of two short forms of the Wisconsin Card Sorting Test. Archives of Clinical Neuropsychology 6, 2733.CrossRefGoogle ScholarPubMed
Rose, D, Willis, R, Brohan, E, Sartorius, N, Villares, C, Wahlbeck, K, Thornicroft, G (2011). Reported stigma and discrimination by people with a diagnosis of schizophrenia. Epidemiology and Psychiatric Sciences 20, 193204.Google Scholar
Rotter, JB (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied 80, 128.CrossRefGoogle ScholarPubMed
Rotter, JB (1990). Internal versus external control of reinforcement: a case history of a variable. American Psychologist 45, 489493.Google Scholar
Ruggeri, M, Tansella, M (2012). People centred mental health care. The interplay between the individual perspective and the broader health care context. Epidemiology and Psychiatric Sciences 21, 125129.Google Scholar
Saraceno, B (2012). Two pressing needs: to measure social integration and to reorient mental health services towards social integration. Epidemiology and Psychiatric Sciences. doi: http://dx.doi.org/10.1017/S2045796012000297. Published online: 15 May 2012.Google Scholar
Seligman, MEP, Castellon, C, Cacciola, J, Schulman, P, Luborsky, L, Ollove, M, Downing, R (1998). Explanatory style change during cognitive therapy for unipolar depression. Journal of Abnormal Psychology 97, 1318.CrossRefGoogle Scholar
SE-SURG (South Essex Service User Research Group), Secker J, Gelling L (2006). “Still dreaming: service users' employment, education and training goalsJournal of Mental Health 15(1): 103111Google Scholar
Sharp, HM, Fear, CF, Healy, D (1997). Attributional style and delusions: an investigation based on delusional content. European Psychiatry 12, 17.CrossRefGoogle ScholarPubMed
Slade, M, Leamy, M, Bacon, F, Janosik, M, Le Boutillier, C, Williams, J, Bird, V (2012). International differences in understanding recovery: systematic review. Epidemiology and Psychiatric Sciences 21, 353364.CrossRefGoogle ScholarPubMed
Smith-Seemiller, L, Franzen, MD, Bowers, D (1997). Use of Wisconsin card sorting test short forms in clinical samples. Clinical Neuropsychologist 11, 421427.Google Scholar
Sprong, M, Schothorst, P, Vos, E, Hox, J, Van Engeland, H (2007). Theory of mind in schizophrenia: meta-analysis. British Journal of Psychiatry 191, 513.Google Scholar
Tansella, M, Thornicroft, G (2009). Implementation science: understanding the translation of evidence into practice. British Journal of Psychiatry 195, 283285.CrossRefGoogle ScholarPubMed
Taylor, JL, Kinderman, P (2002). An analogue study of attributional complexity, theory of mind deficits and paranoia. British Journal of Psychology, 93, 137140.CrossRefGoogle ScholarPubMed
Ventura, J, Nuechterlein, KH, Subotnik, KL, Green, MF, Gitlin, MJ (2004). Self-efficacy and neurocognition may be related to coping responses in recent-onset schizophrenia. Schizophrenia Research 69, 343352.CrossRefGoogle ScholarPubMed
Ware, NC, Hopper, K, Tugenberg, T, Dickey, B, Fisher, D (2007). Connectedness and citizenship: redefining social integration. Psychiatric Services 58, 469474.CrossRefGoogle ScholarPubMed
Warner, R (2010). Does the scientific evidence support the recovery model? Psychiatrist 34, 35.Google Scholar
Weiner, B (1986). An Attribution Theory of Motivation and Emotion. Springer Verlag: New York.Google Scholar
Weiner, B (1995). Judgements of Responsibility. Guilford: New York.Google Scholar
Williams, LM, Whitford, TJ, Flynn, G, Flynn, G, Wong, W, Liddell, BJ, Silverstein, S, Gordon, E (2008). General and social cognition in first episode schizophrenia: Identification of separable factors and prediction of functional outcome using the IntegNeuro test battery. Schizophrenia Research 99, 182191.Google Scholar
World Health Organization (1992). The ICD-10 International Classification of Diseases and Related Health Problems, 10th Version ed. WHO: Geneva.Google Scholar