Factors influencing self-assessment of cognition and functioning in schizophrenia: Implications for treatment studies

Abstract

Awareness of illness is a major factor in schizophrenia and extends into unawareness of cognitive and functional deficits. This unawareness of functional limitations has been shown to be influenced by several different predictive factors, including greater impairment and less severe depression. As treatment efforts are aimed at reducing cognitive deficits, discovery of the most efficient assessment strategies for detection of cognitive and functional changes is critical. In this study, we collected systematic assessments from high contact clinicians focusing on their impressions of the cognitive deficits and everyday functioning in a sample of 169 community dwelling patients with schizophrenia. The patients provided self-report on those same rating scales, as well as self-reporting their depression and performing an assessment of cognitive performance and functional skills. There was essentially no correlation between patients' self reports of their cognitive performance and functional skills and either clinician ratings of these skills or the results of the performance-based assessments. In contrast, clinician reports of cognitive impairments and everyday functioning were correlated with objective performance data. Depression on the part of patients was associated with ratings of functioning that were both more impaired and more congruent with clinician impressions, while overall patients reported less impairment than clinicians. These results underscore the limitations of self reported cognitive functioning even with structured rating scales. Concurrently, clinicians provided ratings of cognitive performance that were related to scores on objective tests, even though they were unaware of the results of those assessments.

Social competence versus negative symptoms as predictors of real world social functioning in schizophrenia

“…The methods used to collect these samples were described in three separate papers (Bowie et al, 2008; Durand et al, in press; Harvey et al, 2011). …”

“…While the same real-world social functioning measure, clinical ratings, and social skills measures were used, these studies were conducted in four separate geographical areas, have no overlap of patients, testers, or clinicians, and reflect a wide range of demographic and ethnic variation in the participants. Though some results regarding correlational aspects between symptoms, social competence, and everyday social outcomes have been published from the three studies (Bowie et al, 2006; 2008; Leifker et al, 2009; Sabbag et al, 2011; Durand et al, in press), the pooled sample size increases our ability to detect correlational relationships between these predictor variables and has not been used previously to address the particular questions of interest in this study.…”

Depression in Schizophrenia: Associations With Cognition, Functional Capacity, Everyday Functioning, and Self-Assessment

“…Very low levels of subjective depression may signal significant difficulty in self-rating level of everyday functioning and objective abilities. 41 Thus, informant ratings may be required for establishing an accurate level of functional impairment in schizophrenia and other neuropsychiatric conditions. …”

Factors influencing self-assessment of cognition and functioning in bipolar disorder: a preliminary study

“…Impaired awareness appears to apply to awareness of functional deficits as well. Self-assessments of functioning on the part of people with schizophrenia have consistently been found to be inaccurate compared to the observations of high contact clinicians, trained interviewers, and achievement of objective milestones such as sustaining full time employment (Bowie et al, 2007; Durand et al, 2015; Gould et al, in press; Harvey et al, 2012; Keefe et al, 2015; Sabbag et al, 2011). …”