Global assessment of psychosocial functioning and predictors of outcome in schizophrenia

Stefanopoulou, Evgenia; Lafuente, Antonio Romero; Fonseca, Andres; Keegan, Shaun; Vishnick, Celia; Huxley, Adam

doi:10.3109/13651501.2010.519035

Cited by 17 publications

(7 citation statements)

References 50 publications

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“…Lastly, we should also acknowledge the absence of clinical measures, aside from apathetic social withdrawal and depressed mood. Studies showed that clinical variables, including positive and negative symptoms as well as the course of illness, are associated with poorer levels of everyday functioning (Smith et al, 2002; Stefanopoulou et al, 2011). However, the literature argues that psychopathology has a relatively low predictive value of daily functioning, since the functional disruption persists after achieving a psychopathological stabilization (González-Blanch et al, 2010; Menezes et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Communicative-pragmatic abilities mediate the relationship between cognition and daily functioning in schizophrenia.

Agostoni¹,

Bambini²,

Bechi³

et al. 2021

Neuropsychology

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Objective: Pragmatics refers to the capacity to understand the speaker’s meaning and thus to appropriately engage in a conversation. This study aims at establishing the role of communicative-pragmatic abilities in functioning, defined as a set of daily activities, in schizophrenia. This would contribute to enrich current models of the neurocognitive predictors of functioning, which have so far neglected pragmatics. Method: One hundred people with schizophrenia underwent a comprehensive assessment including functioning, cognition, theory of mind (ToM), and pragmatics. We tested the effects of cognition as a predictor of functioning, first mediated by ToM, then sequentially mediated by ToM and pragmatics. Next, we explored the predictive effect of cognition, sequentially mediated by ToM and pragmatics, on different functional domains (i.e., interpersonal relations, instrumental role, and personal autonomy). Results: The first model confirmed that ToM acts as a mediator between cognition and functioning. Importantly, the second model highlighted also the main mediating role of pragmatics. The mediation models on different functional domains showed that, when considered together, both pragmatics and ToM significantly influenced all aspects of functioning. When considered separately, pragmatics was significantly related to interpersonal functioning, while ToM to personal autonomy. Conclusions: Innovatively, our findings highlight that pragmatics has a main role, both direct and indirect, in affecting functioning. Of particular interest is that the impact of pragmatics encompasses different functional domains, and especially interpersonal functioning.

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Section: Discussionmentioning

confidence: 99%

Communicative-pragmatic abilities mediate the relationship between cognition and daily functioning in schizophrenia.

Agostoni¹,

Bambini²,

Bechi³

et al. 2021

Neuropsychology

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“…Age at onset is one of the most commonly analysed predictor of outcome in schizophrenia but the results obtained in different original studies are far from conclusive: some have found a lower age at onset to have a positive effect on outcomes (Bland & Parker, ; Bland, Parker, & Orn, ; Stefanopoulou et al, ; Stephens, Richard, & McHugh, ), some a negative effect (Altamura, Bassetti, Sassella, Salvadori, & Mundo, ; Juola, Miettunen, Veijola, Isohanni, & Jääskeläinen, ) and others no effect at all (Üçok, Gorwood, & Karadayı, ). In their systematic review, Menezes and colleagues studied age at onset alongside other predictors of “good” and “bad” outcomes, functional recovery, intermediate outcome, relapse, readmission, Global Assessment of Functioning (GAF) Scale and employment/education in first‐episode psychosis.…”

Section: Introductionmentioning

confidence: 99%

Age at onset and the outcomes of schizophrenia: A systematic review and meta‐analysis

Immonen

Jääskeläinen

Korpela

et al. 2017

Early Intervention Psych

226

116

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The aim of this study was to analyse the effect of age at onset on the long‐term clinical, social and global outcomes of schizophrenia through a systematic review and a meta‐analysis. Original studies were searched from Web of Science, PsycINFO, Pubmed and Scopus, as well as manually. Naturalistic studies with at least a 2‐year follow‐up were included. Of the 3509 search results, 81 articles fulfilled the inclusion criteria. The meta‐analysis was performed in Stata as a random‐effect analysis with correlation coefficients between age at onset and the outcomes (categorized into remission, relapse, hospitalization, positive symptoms, negative symptoms, total symptoms, general clinical outcome, employment, social/occupational functioning and global outcome). There was a statistically significant (P < .05) correlation between younger age at onset and more hospitalizations (number of studies, n = 9; correlation, r = 0.17; 95% confidence interval, CI 0.09–0.25), more negative symptoms (n = 7; r = 0.14; 95% CI 0.01–0.27), more relapses (n = 3; r = 0.11; 95% CI 0.02–0.20), poorer social/occupational functioning (n = 12; r = 0.15; 95% CI 0.05–0.25) and poorer global outcome (n = 13; r = 0.14; 95% CI 0.07–0.22). Other relationships were not significant. This was the first systematic review of the effects of age at onset on the long‐term outcomes of schizophrenia. The results show that age at onset has a small, but significant impact on some of the outcomes of schizophrenia.

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“…Positive and negative symptoms have been consistently found to be minimally related to functional competence, but they are often found to be associated with poorer everyday real world performance even after other factors, such as functional competence, are considered (e.g., Bowie et al, 2006; 2008; 2010; Leifker et al, 2009; Sabbag et al, 2012; Smith et al, 2002; Stefanoloulou et al, 2011). Positive symptoms tend to respond well to pharmaceutical treatment, but approximately 15-20% of people with schizophrenia experience treatment-resistant negative symptoms (Buchanan, 2007) that are strongly associated with poor functional outcomes (e.g., Herbernet & Harrow, 2004; Milev et al, 2005; Leifker et al, 2009; Sabbag et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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

Best

Gupta

Bowie

et al. 2014

Schizophrenia Research: Cognition

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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.

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Global assessment of psychosocial functioning and predictors of outcome in schizophrenia

Cited by 17 publications

References 50 publications

Communicative-pragmatic abilities mediate the relationship between cognition and daily functioning in schizophrenia.

Communicative-pragmatic abilities mediate the relationship between cognition and daily functioning in schizophrenia.

Age at onset and the outcomes of schizophrenia: A systematic review and meta‐analysis

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

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