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Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs

BACKGROUND: We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. METHODS: Demographic, clinical, and psychosocial measures were obtained for 276 participants from the Recovery After an Initi...

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Autores principales: Miley, Kathleen, Meyer-Kalos, Piper, Ma, Sisi, Bond, David J., Kummerfeld, Erich, Vinogradov, Sophia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106305/
https://www.ncbi.nlm.nih.gov/pubmed/37310333
http://dx.doi.org/10.1017/S0033291721003780
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author Miley, Kathleen
Meyer-Kalos, Piper
Ma, Sisi
Bond, David J.
Kummerfeld, Erich
Vinogradov, Sophia
author_facet Miley, Kathleen
Meyer-Kalos, Piper
Ma, Sisi
Bond, David J.
Kummerfeld, Erich
Vinogradov, Sophia
author_sort Miley, Kathleen
collection PubMed
description BACKGROUND: We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. METHODS: Demographic, clinical, and psychosocial measures were obtained for 276 participants from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) trial at baseline and 6-months, along with measures of social and occupational functioning from the Quality of Life Scale. The Greedy Fast Causal Inference algorithm was used to learn a partial ancestral graph modeling causal relationships across baseline variables and 6-month functioning. Effect sizes were estimated using a structural equation model. Results were validated in an independent dataset (N = 187). RESULTS: In the data-generated model, greater baseline socio-affective capacity was a cause of greater baseline motivation [Effect size (ES) = 0.77], and motivation was a cause of greater baseline social and occupational functioning (ES = 1.5 and 0.96, respectively), which in turn were causes of their own 6-month outcomes. Six-month motivation was also identified as a cause of occupational functioning (ES = 0.92). Cognitive impairment and duration of untreated psychosis were not direct causes of functioning at either timepoint. The graph for the validation dataset was less determinate, but otherwise supported the findings. CONCLUSIONS: In our data-generated model, baseline socio-affective capacity and motivation are the most direct causes of occupational and social functioning 6 months after entering treatment in early schizophrenia. These findings indicate that socio-affective abilities and motivation are specific high-impact treatment needs that must be addressed in order to promote optimal social and occupational recovery.
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spelling pubmed-101063052023-04-17 Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs Miley, Kathleen Meyer-Kalos, Piper Ma, Sisi Bond, David J. Kummerfeld, Erich Vinogradov, Sophia Psychol Med Original Article BACKGROUND: We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. METHODS: Demographic, clinical, and psychosocial measures were obtained for 276 participants from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) trial at baseline and 6-months, along with measures of social and occupational functioning from the Quality of Life Scale. The Greedy Fast Causal Inference algorithm was used to learn a partial ancestral graph modeling causal relationships across baseline variables and 6-month functioning. Effect sizes were estimated using a structural equation model. Results were validated in an independent dataset (N = 187). RESULTS: In the data-generated model, greater baseline socio-affective capacity was a cause of greater baseline motivation [Effect size (ES) = 0.77], and motivation was a cause of greater baseline social and occupational functioning (ES = 1.5 and 0.96, respectively), which in turn were causes of their own 6-month outcomes. Six-month motivation was also identified as a cause of occupational functioning (ES = 0.92). Cognitive impairment and duration of untreated psychosis were not direct causes of functioning at either timepoint. The graph for the validation dataset was less determinate, but otherwise supported the findings. CONCLUSIONS: In our data-generated model, baseline socio-affective capacity and motivation are the most direct causes of occupational and social functioning 6 months after entering treatment in early schizophrenia. These findings indicate that socio-affective abilities and motivation are specific high-impact treatment needs that must be addressed in order to promote optimal social and occupational recovery. Cambridge University Press 2023-04 2021-10-08 /pmc/articles/PMC10106305/ /pubmed/37310333 http://dx.doi.org/10.1017/S0033291721003780 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
spellingShingle Original Article
Miley, Kathleen
Meyer-Kalos, Piper
Ma, Sisi
Bond, David J.
Kummerfeld, Erich
Vinogradov, Sophia
Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs
title Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs
title_full Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs
title_fullStr Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs
title_full_unstemmed Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs
title_short Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs
title_sort causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106305/
https://www.ncbi.nlm.nih.gov/pubmed/37310333
http://dx.doi.org/10.1017/S0033291721003780
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