Course patterns of psychosocial functioning in schizophrenia patients attending a vocational rehabilitation program.

Although considerable research has been undertaken on psychosocial treatment and rehabilitation of patients with chronic schizophrenia, few studies have examined individual courses by means of repeated and frequent observation. A more dynamic view of rehabilitation might disclose patterns of response useful for both understanding and treating symptoms and disabilities associated with chronic schizophrenia. In an exploratory study, time series of 35 schizophrenia outpatients participating in a vocational rehabilitation program were examined by a relatively original quantitative approach to the identification of dynamical patterns. By using time series regression on weekly behavioral ratings, dynamical properties of mean, trend, and variability were calculated. Cluster analysis revealed five subgroups of courses: (1) stable at a high level, (2) fluctuating at a middle level, (3) at a middle level, tending toward a slight descent, (4) showing a steep descent, and (5) unstable at a low level of functioning. The subgroups varied at intake in psychopathology; in cognitive dysfunction; and in measures of self-concept, locus of control, and coping. At program end, pronounced differences were found among the subgroups in vocational reintegration. These different dynamical patterns can be understood as typical pathways linking patient characteristics to rehabilitation outcome. A broader use of dynamical designs could substantially clarify the variety of reactions of patients to psychosocial interventions.