PMID- 25650684
OWN - NLM
STAT- MEDLINE
DCOM- 20150324
LR  - 20150205
IS  - 1555-2101 (Electronic)
IS  - 0160-6689 (Linking)
VI  - 76
IP  - 1
DP  - 2015 Jan
TI  - The association between working alliance and clinical and functional outcome in a 
      cohort of 400 patients with first-episode psychosis: a cross-sectional study.
PG  - e83-90
LID - 10.4088/JCP.13m08814 [doi]
AB  - 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. METHOD: 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 (beta = -0.12; 
      95% CI, -0.19 to -0.04) and disorganized symptoms (beta = -0.06; 95% CI, -0.11 to 
      -0.01), and between working alliance and better social functioning (beta = 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. TRIAL 
      REGISTRATION: ClinicalTrials.gov identifier: NCT00914238.
CI  - (c) Copyright 2015 Physicians Postgraduate Press, Inc.
FAU - Melau, Marianne
AU  - Melau M
AD  - Mental Health Centre Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 
      23, opg.13A, 3. 2400 Copenhagen NV, 0045 20607551 Denmark 
      Marianne.melau@regionh.dk.
FAU - Harder, Susanne
AU  - Harder S
FAU - Jeppesen, Pia
AU  - Jeppesen P
FAU - Hjorthoj, Carsten
AU  - Hjorthoj C
FAU - Jepsen, Jens R M
AU  - Jepsen JR
FAU - Thorup, Anne
AU  - Thorup A
FAU - Nordentoft, Merete
AU  - Nordentoft M
LA  - eng
SI  - ClinicalTrials.gov/NCT00914238
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Psychiatry
JT  - The Journal of clinical psychiatry
JID - 7801243
SB  - IM
MH  - Adult
MH  - Case Management/*standards
MH  - Cohort Studies
MH  - Cross-Sectional Studies
MH  - Denmark
MH  - Female
MH  - Humans
MH  - Male
MH  - Patient Compliance/*psychology
MH  - *Professional-Patient Relations
MH  - Psychotic Disorders/psychology/*therapy
MH  - Randomized Controlled Trials as Topic
MH  - Schizophrenia/*therapy
MH  - *Schizophrenic Psychology
MH  - Young Adult
EDAT- 2015/02/05 06:00
MHDA- 2015/03/25 06:00
CRDT- 2015/02/05 06:00
PHST- 2013/09/27 00:00 [received]
PHST- 2014/04/21 00:00 [accepted]
PHST- 2015/02/05 06:00 [entrez]
PHST- 2015/02/05 06:00 [pubmed]
PHST- 2015/03/25 06:00 [medline]
AID - 10.4088/JCP.13m08814 [doi]
PST - ppublish
SO  - J Clin Psychiatry. 2015 Jan;76(1):e83-90. doi: 10.4088/JCP.13m08814.