Resumption of work or studies after first-episode psychosis: the impact of vocational case management.

BACKGROUND:Psychosis compromises the educational and professional projects of young patients. Vocational case management (VCM) offers comprehensive support for reintegration into work or studies within an early psychosis intervention programme. AIMS:To evaluate the effectiveness of VCM in resumption of work or school and to identify the predictive factors of occupational outcome. METHODS:This descriptive study focused on occupational status of an early psychosis cohort during the first 5 years of VCM. RESULTS:56.6% of 97 study subjects had a diagnosis of schizophrenia, 32% had type I bipolar disorder with psychotic features. 68% held a productive occupation the year prior to admission, and 47.4% at admission. The occupational rate rose from 57.1% at 12 months to over 70% after 48 months. 65.6% maintained or improved their occupational status. Most subjects held competitive employment, and the employment rate was similar to that of the general population. Prior employment and affective psychosis were associated with better outcome. [Correction added on 2 April 2013, after first online publication: 'Non-affective psychosis' has been changed to 'affective psychosis' in the Results section.] CONCLUSION:The majority of individuals suffering from early psychosis resume productive activity rapidly when offered VCM within an early intervention programme during a follow-up period of up to 5 years.