A longitudinal examination of the moderating effects of symptoms on the relationship between functional competence and real world functional performance in Schizophrenia

Abstract

Background Many individuals with schizophrenia experience remission of prominent positive symptoms but continue to experience impairments in real world functioning. Residual negative and depressive symptoms may have a direct impact on functioning and impair patients’ ability to use the cognitive and functional skills that they possess (competence) in the real world (functional performance). Methods 136 individuals (100 men, 36 women) with schizophrenia were classified as having primarily positive symptoms, primarily negative symptoms, primarily depressive symptoms, or undifferentiated symptom profiles. Performance based measures of cognition and adaptive and interpersonal functional competence were used, along with ratings of real world behavior by high contact clinicians. Assessments were performed at baseline and at an 18-month follow-up. Results The relationships between neurocognition and capacity / performance were not moderated by symptom group ps > .091; neurocognition predicted capacity and performance for all groups ps < .001. The relationship between adaptive competence and adaptive performance was moderated by symptom group, ps < .01, such that baseline competence only predicted future performance ratings for participants with primarily positive or undifferentiated symptoms, and not for individuals with primarily negative or depressive symptoms. This same moderation effect was found on the relationship between interpersonal competence and interpersonal performance, ps < .002. Conclusions Residual negative and depressive symptoms are distinct constructs that impede the use of functional skills in the real world. Depressive symptoms are often overlooked in schizophrenia but appear to be an important factor that limits the use of functional ability in real world environments.

From hospital admission to independent living: Is prediction possible?

“…The fact that cognition was found to be correlated with daily functioning is in line with previous research (Green et al, 2004a;Wittorf et al, 2008;Vesterager et al, 2012;Best et al, 2014). Despite the multiple correlations between cognitive components and functional measurements in the present study, only a few were entered into the regression analysis: executive functions, naming, attention, orientation, and construction.…”

“…The functional decline that occurs in people with schizophrenia has been widely investigated in community settings over the last decade (e.g. Twamley et al, 2002;Siegel et al, 2006;Bowie et al, 2006Bowie et al, , 2008Sitzer et al, 2008;Harvey et al, 2011;Vesterager et al, 2012;Best et al, 2014). However, the ability to predict daily functioning based on information obtained during hospitalization has only been partially established (Wittorf et al, 2008;Spellmann et al, 2012).…”

“…There is consistent evidence regarding the influence of cognition on daily functioning (e.g. Keefe et al, 2006;Siegel et al, 2006;Bowie et al, 2006Bowie et al, , 2008Harvey et al, 2011;Vesterager et al, 2012;Best et al, 2014). Still, the specific cognitive domains and extent of their influence varies among studies (Green et al, 2000(Green et al, , 2004a(Green et al, , 2004bVesterager et al, 2012).…”

“…Findings regarding the effect of schizophrenia symptoms on daily functioning are inconsistent. There are a number of studies that demonstrate the influence of both negative and positive symptoms on different parameters of daily functioning, such as independence in one's current living situation or functional capacity to maintain one's home Twamley et al, 2002;Evans et al, 2003;Bowie et al, 2006;Vesterager et al, 2012;Best et al, 2014). Yet, some studies did not find that negative or positive symptoms impacted daily functioning (Addington and Addington, 1999;Velligan et al, 2000;Bell and Bryson, 2001).…”

“…Keefe et al, 2006;Bowie et al, 2008;Mausbach et al, 2008;Leifker et al, 2009;Harvey et al, 2011). Studies that use functional capacity assessments as a predictor demonstrate that it predicts independent living and the ability to function in the real-world (e.g., interpersonal skills, work skills, and community activities) (Bowie et al, 2006;Mausbach et al, 2008;Best et al, 2014). Two studies that followed up with people who had schizophrenia 1 year after discharge from the hospital identified psychopathological, cognitive, and socio-demographic factors as predictors of functional outcomes and remission after discharge.…”