Schizophrenic Disorders

Common Functional Limitations

Interpersonal skills (cooperation), tact, and assisting
Self-direction (dependability, decision making, difficulty with frequent change)
Stamina
Understanding instructions (particularly if these involve understanding underlying principles, reasoning, etc.)
Motor coordination
Eye-hand-foot coordination
Form perception
Spatial perception
Memory
Problem solving
Flexibility and adapting to change

Vocational Impediments

Most of the functional limitations described above, either alone or in combination with others, constitute substantial impediments to employment. Consequently, establishing the presence of vocational impediments is usually not an issue.

Persons with schizophrenia commonly lead isolated and sedentary lives. They are deconditioned and lack the stamina to get through an eight-hour day, and the strength to perform some types of work.

Problems in learning new jobs and understanding instructions play a major part in determining the vocational handicap. These individuals often have difficulty understanding, reasoning, and making judgments by applying instructions, procedures, or rules. They often lack the logic necessary to deal with specific situations and events encountered on the job.

They may have difficulty communicating with others because of delusions and hallucinations that intrude into ordinary conversation. They may also have a blunted emotional response, making it difficult for others to comprehend what they are trying to communicate.

A variety of drug side effects may also impair motor functioning including walking, climbing, and balancing.

Rehabilitation research has identified some indicators of successful VR outcome. These are summarized in the table below.

Indicators of Vocational Rehabilitation Outcome
Category	VR Prognostic Indicator	Favorable vs. Unfavorable
Clinical Course and Symptoms	Age at first onset Duration of acute disturbance Extent of impact on functioning Type of onset Inter-episode interval Frequency of acute episodes Self-injurious behavior Assaultive behavior Mental illness in family	Older vs. younger Short vs. long Limited vs. pervasive Rapid vs. slow Long vs. short Infrequent vs. frequent Absent vs. present Absent vs. present Absent vs. present
Vocational and Educational History	Stable work history Identifiable work skills Educational level	Present vs. absent Present vs. absent HS or above vs. less
Other Disabilities	Physical illness Alcohol or drug abuse	Absent vs. present Absent vs. present
Cognitive Functioning	Intelligence level	High vs. low

Ability to achieve a vocational outcome also involves consideration of three broad factors beyond those listed above. These are:

Participation in and compliance with a medical management program. Continuing medical management of schizophrenia using neuroleptic medications is essential. Although some schizophrenics can be maintained without drug therapy, this should be done only under medical supervision. Additionally, as the client gets involved in an active vocational rehabilitation program, his or her medication needs may change.
Stable social support, living situation, and finances. The presence of strong family support, a stable living situation, and an income adequate to meet basic needs (either from the family or an income maintenance program) are essential for vocational rehabilitation success. In the absence of these, VR plans break down because a person's basic needs for food, clothing, shelter, and security are over-riding priorities.
Availability of services necessary to overcome each specific vocational handicap and employment barrier. Successful vocational rehabilitation depends on overcoming all of the persons identified handicaps to employment, not just a select few.