Determinants of Real-World Functional Performance  in Schizophrenia Subjects: Correlations With Cognition, Functional Capacity, and Symptoms

Bowie, Christopher R.; Reichenberg, Abraham; Patterson, Thomas L.; Heaton, Robert K.; Harvey, Philip D.

doi:10.1176/appi.ajp.163.3.418

Cited by 683 publications

(529 citation statements)

References 27 publications

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“…For example, the brevity of the UPSA (i.e., 30 minutes) makes it preferable to lengthy batteries assessing multiple cognitive domains. Indeed recent research (Bowie et al, 2006;Keefe et al, 2006) has indicated that the prediction of real-world outcomes is not enhanced by cognitive performance when scores on the UPSA are considered. In addition, unlike assessments of global cognitive functioning (e.g., DRS) healthcare professionals do not need specialized training in order to administer the UPSA.…”

Section: Discussionmentioning

confidence: 99%

“…Participants receive scores for each of the 5 subscales (range = 0-20), which are summed to create a summary score ranging from 0 to 100. Previous research has established that the UPSA is highly related to neurocognitive functioning (Bowie et al, 2006;Twamley et al, 2002) and performance on a number of functional abilities (Bowie et al, 2006). ' Dementia Rating Scale (DRS;Mattis, 1973) was administered as an assessment of overall cognitive functioning.…”

Section: Methodsmentioning

confidence: 99%

“…For example, recent research has examined various determinants of real-world functional performance in patients with schizophrenia, including the severity of neurocognitive deficits. These studies indicate that neurocognitive functioning is related to interpersonal skills, engagement in community activities, and work skills (Bell & Bryson, 2001;Bowie et al, 2006;Bryson & Bell, 2003;Bryson et al, 1998). For example, Green et al showed that neurocognitive deficits significantly impaired patients' daily functioning abilities (Green, 1996;Green et al, 2000), including success in psychosocial skill acquisition (e.g., learning basic conversation skills and medication management), acquisition of instrumental skills and social problem-solving ability (e.g., role-playing performance of skills), and community outcomes/daily activities (e.g., occupational functioning, social attainment, degree of independent living).…”

Section: Introductionmentioning

confidence: 96%

“…These studies have examined the ability to perform specific, functionally relevant, everyday living skills in controlled assessment settings. In a study of older patients with schizophrenia, Bowie et al (2006) examined the role of neurocognitive functioning and functional skills capacity in predicting real-world functional performance (e.g., personal care skills, interpersonal skills, community activities) as rated by case managers with extensive contact with the patients. Functional capacity was measured with the UCSD Performancebased Skills Assessment (UPSA; Patterson et al, 2001), a performance-based measure assessing the ability to adequately perform a number of everyday functional tasks such as comprehending written material, planning activities, and managing money.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of the UCSD performance-based skills assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia

Mausbach

Bowie

Harvey

et al. 2008

Journal of Psychiatric Research

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The objective of this study was to examine the sensitivity and specificity of a performance-based measure of functional capacity, the UCSD Performance-Based Skills Assessment (UPSA) for the prediction of independent living status in patients with chronic schizophrenia-related conditions. A sample of 434 adults with schizophrenia or schizoaffective disorder was administered the UPSA and assessed for independent living status. Participants were classified as "independent" if they were living alone in an apartment, house, or single-resident occupancy (e.g., hotel room) and nonindependent if they resided in a care facility (e.g., Board-and-Care home, Skilled Nursing Facility). Receiver Operator Characteristic (ROC) curves were calculated with the UPSA and Mattis' Dementia Rating Scale (DRS) scores as predictor variables and residential independence as the state variable. Of the 434 participants, 99 (23%) were living independently at the time of assessment. The discriminant validity of the UPSA was adequate (ROC area under the curve = 0.74; 95% CI: 0.68-0.79), with greatest dichotomization for the UPSA at a cutoff score of 75 (68% accuracy, 69% sensitivity, 66% specificity), or 80 (68% accuracy, 59% sensitivity, 76% specificity). The UPSA was also a significantly better predictor of living status than was the DRS, based on ROC (z = 2.43, p = . 015). The UPSA is a brief measure of functional capacity that predicts the ability of patients with schizophrenia to reside independently in the community.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Usefulness of the UCSD performance-based skills assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia

Mausbach

Bowie

Harvey

et al. 2008

Journal of Psychiatric Research

Self Cite

116

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“…While it could be argued that the generalizability of this method may be limited because there may be differences between patients' competence or capacity (i.e., what they can do) and performance in the real world (i.e., what they actually do), functional capacity may also be less likely to be influenced by factors outside the control of treatment interventions (e.g., disability status, familial financial resources). In fact, we have demonstrated that functional capacity (what a patient can do), based on performance in a laboratory setting, is moderately correlated with real world deployment of those skills, but strongly correlated with performance on measures of cognitive functioning (Twamley et al, 2002;Bowie et al, 2006).…”

Section: Introductionmentioning

confidence: 89%

Self-assessment of functional status in schizophrenia

Bowie

Twamley

Anderson

et al. 2007

Journal of Psychiatric Research

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172

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With new treatments targeting features of schizophrenia associated with functional disability, there is a need to evaluate the validity of ratings of everyday outcomes. It is unknown whether patients can validly self-report on aspects of their functional status, which would be a potentially economical method for obtaining outcome data. In this study, 67 older schizophrenia outpatients provided self-ratings of everyday real-world functioning using the specific levels of functioning scale (SLOF). They were also administered assessments of neuropsychological performance, performance-based measures of functional capacity and social skills, clinical symptoms, and quality of life. Case managers, unaware of other ratings, also generated SLOF ratings. Based on discrepancy scores, participants were categorized as accurate raters (n = 24), underestimators (n = 16), or overestimators (n = 27) of their functional status as compared to case managers' ratings. Patients' self-rated functional status was correlated with their subjective quality of life, but remarkably unassociated with case manager ratings of functional status or their own performance on functional capacity or social skills measures. Case manager ratings, however, were highly correlated with performance on functional capacity and social skills measures. Patients who underestimated their real world performance had better cognitive skills and greater self-rated depression than those who overestimated. Accurate raters demonstrated greater social skills than both overestimators and underestimators, while overestimators were most cognitively and functionally impaired. Accurate ratings of everyday outcomes in schizophrenia may require systematic observation of real world outcomes or performance-based measures, as self-reports were inconsistent with objective information.

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From Perception to Functional Outcome in Schizophrenia

Green¹,

Hellemann²,

Horan³

et al. 2012

Arch Gen Psychiatry

348

297

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Context Schizophrenia remains a highly disabling disorder, but the specific determinants and pathways that lead to functional impairment are not well understood. It is not known whether these key determinants of outcome lie on one or multiple pathways. Objective This study evaluated theoretically-based models of pathways to functional outcome starting with early visual perception. The intervening variables were previously established determinants of outcome drawn from two general categories: ability (i.e., social cognition and functional capacity) and beliefs / motivation (i.e., defeatist beliefs, expressive and experiential negative symptoms). We evaluated an integrative model in which these intervening variables formed a single pathway to poor outcome. Design This was a cross-sectional study that applied structural equation modeling to evaluate the relationships among determinants of functional outcome in schizophrenia. Setting Assessments were conducted at a Veterans Administration (VA) Medical Center. Participants One hundred ninety one clinically-stable outpatients with schizophrenia or schizoaffective disorder were recruited from the community. Results A measurement model showed that the latent variables of perception, social cognition, and functional outcome were well-reflected by their indicators. An initial untrimmed structural model with functional capacity, defeatist beliefs, and expressive and experiential negative symptoms had good model fit. A final trimmed model was a single path running from perception to ability to motivational variables to outcome. It was more parsimonious and had better fit indices than the untrimmed model. Further, it could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from perception to outcome was significant. Conclusions The final structural model was a single pathway running from perception to ability to beliefs / motivation to outcome. Hence, both ability and motivation appear to be needed for community functioning, and can be modeled effectively on the same pathway.

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Determinants of Real-World Functional Performance in Schizophrenia Subjects: Correlations With Cognition, Functional Capacity, and Symptoms

Cited by 683 publications

References 27 publications

Usefulness of the UCSD performance-based skills assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia

Usefulness of the UCSD performance-based skills assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia

Self-assessment of functional status in schizophrenia

From Perception to Functional Outcome in Schizophrenia

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