Executive dysfunction in schizophrenia: Predictors of the discrepancy between subjective and objective measures

Abstract

This study aimed to investigate what characterizes individuals with schizophrenia who experience more or less subjective executive dysfunction in everyday life compared to objective executive performance on neuropsychological tests. Sixty-six participants with broad schizophrenia spectrum disorders completed a comprehensive assessment of executive function. Discrepancies between performance on neuropsychological tests (objective) and an extensive self-report questionnaire (subjective) of central executive functions (inhibition, shifting and working memory) were calculated. Higher level of self-efficacy was the best predictor of experiencing fewer subjective cognitive complaints compared to objective performance, followed by higher levels of disorganized symptoms. Depressive symptoms did not predict discrepancy between subjective and objective executive function. Higher estimated IQ predicted greater subjective working memory difficulties in everyday life despite better objective performance. Results may aid clinicians in the assessment and remediation of cognitive impairment. Low self-efficacy may identify individuals who are not able to utilize their potential executive functions in daily life. Interventions aimed at fostering self-efficacy ought to be included in cognitive remediation for these individuals. Disorganized symptoms could prove useful in identifying individuals who are in need of cognitive remediation for executive dysfunction, despite that they overestimate their skills. These individuals may benefit from efforts to increase insight into cognitive dysfunction.

A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes

“…Furthermore, subjective and objective measures of EF are rarely strongly correlated in neither healthy nor clinical samples [ 85 , 86 ]. One of the main strengths of objective measures is limiting the influence of confounding factors through control over the test situation.…”

Moderators of metacognitive strategy training for executive functioning in early schizophrenia and psychosis risk

“…Measuring both subjective and objective cognition in clinical assessment is important because discrepancy issues may be discovered and discussed with patients. Assisting patients in recognizing relevant everyday examples of cognitive difficulties should be carried out while also supporting self-efficacy and self-esteem ( Cella et al, 2014 ; Haugen et al, 2021 ; Saperstein et al, 2020 ). Developing individual goals using a structured approach such as Goal Attainment Scaling may help to identify motivating opportunities for practicing cognitive remediation strategies for patients regardless of living arrangements and employment status ( Ashford and Turner-Stokes, 2006 ; Krasny-Pacini et al, 2014 ).…”

“…Another potential moderator of treatment effect of GMT is the discrepancy between subjectively and objectively assessed executive function. A substantial portion of people with schizophrenia report fewer subjective cognitive complaints relative to their objectively measured difficulties ( Harvey and Pinkham, 2015 ; Haugen et al, 2021 ; Potvin et al, 2014 ). Individuals with psychosis risk syndromes, on the other hand, are more likely to report greater subjective complaints compared to objective test performance ( Glenthøj et al, 2020 ).…”

An Assessment of the Evolution of Executive Functions

“…Many studies have shown a strong correlation between executive function problems and psychiatric disorders. For example, schizophrenia (Haugen et al 2021), personality disorders (Garcia-Villamisar et al 2017, Gvirts et al 2015, obsessivecompulsive disorder (Olley et al 2007), major depression (Matsuo et al 2007), anxiety disorders (Warren et al 2021), eating disorders (Blume et al 2019, Diaz-Marsa et al 2023. A fMRI study conducted with 1129 young people with an average age of 15 years found that psychotic symptoms were associated with hypoactivation in the left dorsolateral prefrontal cortex, while behavioral symptoms were associated with hypoactivation in the frontoparietal cortex and cerebellum.…”