title: The effects of the combination of cognitive training and supported employment on improving clinical and working outcomes for people with schizophrenia in Japan.
abstract: BACKGROUND
  In Japan, Job assistance for SMI have been not active. Compared with mental retardation, employment rate of SMI was low. The needs of the effective job assistance for SMI are growing. The purpose of this study was to determine the effectiveness of the combination approach of Cognitive Remediation (CR) and Supported Employment (SE) in clinical outcomes, including cognitive functioning and psychiatric symptoms besides vocational outcomes.
  
  
  METHODS
  The participants diagnosed with schizophrenia or schizoaffective disorder were assigned to CR+SE group (n=52) and SE group (n=57). CR comprised computer based trainings using COGPACK and group works. SE was individualized vocational support provided by employment specialists. Outcome measures included cognitive functioning, psychiatric symptoms, social functioning, performance of tasks as clinical outcomes, employment rate, duration of employment, and earned wage as vocational outcome.
  
  
  RESULTS
  CR+SE group displayed significantly better psychiatric symptoms (F=3.490, p<.10), interpersonal relations (F=11.695, p<.01), and social and cognitive functioning including verbal memory (F=9.439, p<.01), digit sequencing (F=5.544, p<.05), token motor tasks (F=6.685, p<.05), and overall cognitive functioning (F=8.136, p<.01). We did not find any significant difference between two groups in terms of employment rate and earned wage.
  
  
  CONCLUSIONS
  This is the first controlled study to determine the effectiveness of CR on vocational outcomes in Japan. The results showed that CR and SE programs were feasible in Japan and that CR using COGPACK had favorable effects on cognitive functioning, psychiatric symptoms, and social functioning, which is consistent with previous researches.
authors.affiliation: Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Sato
authors.affiliation: Outpatient department, Osaka Psychiatric Medical Center, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Department of Rehabilitation, Faculty of Medicine, University of Tokyo, Japan.
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Furukawa
authors.affiliation: Department of Psychiatry, Nara Medical University School of Medicine, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Psychiatry, Teikyo University School of Medicine, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Hatsuse
authors.affiliation: Department of Psychiatry, Teikyo University School of Medicine, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Ikebuchi
keywords: COGPACK.; Schizophrenia; cognitive impairment; cognitive remediation; supported employment