title: The association between working alliance and clinical and functional outcome in a cohort of 400 patients with first-episode psychosis: a cross-sectional study.
abstract: OBJECTIVE
  Working alliance between patients with a first-episode psychosis and their case manager is regarded as a key element in specialized early intervention services. The impact of this patient-case manager dyad on functional and clinical outcome is unknown. We aimed to investigate if a strong working alliance was associated with fewer clinical symptoms and better social functioning.
  
  
  METHODS
  In a cross-sectional design, patients with first-episode schizophrenia spectrum disorders (ICD-10, F20-29) were included after 18 months of treatment (N = 400). Baseline data were collected between June 2009 and December 2011. Symptoms were assessed using Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment of Functioning (GAF), Brief Assessment of Cognition in Schizophrenia (BACS), Working Alliance Inventory (WAI), and General Self-Efficacy (GSE). Linear regression analyses were adjusted for age, sex, cognition, and self-efficacy.
  
  
  RESULTS
  Results revealed significant associations between working alliance and fewer negative (β = -0.12; 95% CI, -0.19 to -0.04) and disorganized symptoms (β = -0.06; 95% CI, -0.11 to -0.01), and between working alliance and better social functioning (β = 1.45; 95% CI, 0.55 to 2.36). General self-efficacy mediated the effect of working alliance, explaining 14%-18% of the variance in associated outcomes. Global level of cognitive functioning, compliance, and self-efficacy influenced clinical and functional outcome more strongly than working alliance.
  
  
  CONCLUSIONS
  Better working alliance was weakly associated with fewer negative and disorganized symptoms and better social functioning. A strong working alliance may be a prerequisite for adherence to the specialized early intervention services treatment, providing the basis for positive treatment outcome.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00914238.
authors: Mental Health Centre Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, opg.13A, 3. 2400 Copenhagen NV, 0045 20607551 Denmark Marianne.melau@regionh.dk.
authors: Marianne
authors: M
authors: Melau
authors: Susanne
authors: S
authors: Harder
authors: Pia
authors: P
authors: Jeppesen
authors: Carsten
authors: C
authors: Hjorthøj
authors: Jens R M
authors: JR
authors: Jepsen
authors: Anne
authors: A
authors: Thorup
authors: Merete
authors: M
authors: Nordentoft
mesh_terms: D000328:Adult; D019090:Case Management / Q000592:standards*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D055815:Young Adult