Motivation and its Relationship to Neurocognition, Social Cognition, and Functional Outcome in Schizophrenia

Gard, David E.; Fisher, Melissa; Garrett, Coleman; Genevsky, Alexander; Vinogradov, Sophia

doi:10.1016/j.schres.2009.08.015

Cited by 185 publications

(140 citation statements)

References 40 publications

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“…However, the analysis of all 36 IPT studies showed that the therapy effects still improved during follow-up. [22][23] Finally, other potentially powerful mediators between cognition and functional outcome are not considered in the analysis, mediators such as motivation 51 or insight (awareness of having a mental illness that requires treatment). 52 And, the analyzed moderator variables in this study -IQ, gender, the duration of treatment -may be influenced by the small sample size.…”

Section: Discussionmentioning

confidence: 99%

Integrated Psychological Therapy: Effectiveness in Schizophrenia Inpatient Settings Related to Patients' Age

Mueller¹,

Schmidt²,

Roder³

2013

The American Journal of Geriatric Psychiatry

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Objective: Elderly people with schizophrenia often suffer from cognitive impairments, which affect their social functioning. Today, only few therapy approaches for middleaged and older patients are available. The Integrated Psychological Therapy (IPT) combines neurocognitive and social cognitive interventions with social skills approaches. The aim of this study was to evaluate (1) whether IPT is effective in younger patients (age<40 years) and middle-aged patients (age≥40 years), and (2) whether control conditions (CC: treatment as usual or unspecific group activities) reveal some change in outcome depending on age. Method: A total of 15 controlled IPT studies with 632 schizophrenia inpatients were included into a standard meta-analytic procedure. Studies were categorized into two age-categories. Results: Significant medium to high effect sizes (ES) were evident for IPT independent of age on the global cognitive score (mean score of all cognitive variables), on neurocognition, social cognition, social functioning, psychopathology, and on the global therapy effect (mean of all variables). The IPT effects in middleaged patients were significantly higher on the global cognitive score, on neurocognition and on social cognition compared to younger patients. Opposite results could be observed in CC. Only younger patients participating in the CC showed small but significant ES on these variables, but almost middle-aged control patients did not. However, none of the differences in CC were significant between the two age-categories. A moderator analysis obtained no evidence for a strong impact of IPT variations, therapy setting, patient characteristics and methodological rigor of the research design. Conclusions: These results support evidence for the efficacy of IPT independent of age. Results further indicate the need of goal-oriented specific psychological interventions for middle-aged and older schizophrenia patients.Keywords: Schizophrenia, aged, middle-aged, elderly, cognition, therapy, integrated therapy, cognitive remediation, meta-analysis 3 There is evidence for a gradual aging of the population in developed countries all over the world, and also an increase of middle-aged and elderly schizophrenia patients. 1 Therefore, research focusing on the impact of the age on schizophrenia features as well as on the successful treatment of these features becomes important. During the last decades, a large bulk of data was published addressing younger people suffering from schizophrenia, but the needs of older schizophrenia patients were often neglected. Recent reviews of published data on the rehabilitation goals for older people with serious mental illness summarized that poor outcome in social functioning and lower quality of life are strongly associated with social isolation, depression, cognitive impairment, and chronic medical illness. 1,2 The authors concluded that specific interventions are needed with regard to these specific features associated with social functioning and quality of life in older patient...

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Section: Discussionmentioning

confidence: 99%

Integrated Psychological Therapy: Effectiveness in Schizophrenia Inpatient Settings Related to Patients' Age

Mueller¹,

Schmidt²,

Roder³

2013

The American Journal of Geriatric Psychiatry

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“…However, an early study by Blanchard and colleagues found no consistent relation of neurocognitive performance with expressive deficits (Blanchard et al, 1994). Moreover, several studies have reported that motivational deficits in schizophrenia were linked to poorer performance on neurocognitive measures (Fervaha et al, 2014a,b;Gard et al, 2009;Nakagami et al, 2008;Roth et al, 2004;Schmand et al, 1994). Recently, studies have investigated correlates of neurocognitive deficits with clinical ratings scales that allow the assessment of both negative symptom dimensions.…”

Section: Introductionmentioning

confidence: 99%

The association of neurocognitive impairment with diminished expression and apathy in schizophrenia

Hartmann-Riemer

Hager

Kirschner

et al. 2015

Schizophrenia Research

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Negative symptoms can be grouped into the two dimensions of diminished expression and apathy, which have been shown to be dissociable regarding external validators, such as functional outcome. Here, we investigated whether these two dimensions differentially relate to neurocognitive impairment in schizophrenia. 47 patients with schizophrenia or schizoaffective disorder and 33 healthy control participants were subjected to a neurocognitive test battery assessing multiple cognitive domains (processing speed, working memory, verbal fluency, verbal learning and memory, mental planning), which are integrated into a composite cognition score. Negative symptoms in patients were assessed using the Brief Negative Symptom Scale. We found that diminished expression significantly related to neurocognitive impairment, while severity of apathy symptoms was not directly associated with neurocognition. Other assessed clinical variables include chlorpromazine equivalents, positive symptoms, and depressive symptoms and did not influence the results. Our results are in line with a cognitive resource limitation model of diminished expression in schizophrenia and indicate that cognitive remediation therapy might be helpful to ameliorate expressive deficits.

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“…Perhaps consequently, few social cognition studies have employed the GAF scale as an outcome measure (Fett et al, 2011). Furthermore, among the few studies that have used the GAF and found that social cognition is a mediator in the relationship between neurocognition and functioning, most did not account for variation in symptom severity (McGlade et al, 2008;Gard et al, 2009;Schmidt et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Social dysfunction in schizophrenia: An investigation of the GAF scale's sensitivity to deficits in social cognition

Robertson

Hargreaves

Kelleher

et al. 2013

Schizophrenia Research

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Background: Schizophrenia is accompanied by significant impairment in psychosocial functioning, which is only partially explained by clinical symptom severity. Recently, these impairments have been strongly associated with deficits in neurocognition and social cognition. Although the Global Assessment of Function (GAF) scale remains the most widely used measure of psychosocial function in clinical practice, it is unclear whether this instrument is sensitive to changes in cognition, or merely provides a snapshot of symptom severity. To investigate this, we assessed whether variation in GAF score was explained by performance on measures of neurocognitive and social cognition, particularly after variation associated with symptom severity had been accounted for. Methods: 216 patients with schizophrenia were assessed using the GAF scale, two theory of mind tasks (the 'Hinting' task and 'Reading the Eyes in the Mind' task), and a neuropsychological battery sensitive to the areas of deficit typically seen in schizophrenia -IQ, episodic memory, working memory and attentional control. Results: Using linear regression analysis, symptom severity explained 24% of the variance in GAF scores (F(3, 188) = 21.14, p b .001). While neuropsychological performance explained a further 4.7% of variation (r 2 change = .047, F change (1, 187) = 12.63, p b .001), social cognition did not explain any further variance in functioning (r 2 change =.006, F change (1, 186)=1.63, p=.20). Conclusion: These data indicate that GAF scores are primarily sensitive to variation in clinical symptoms severity and not at all sensitive to variation in social cognition, an important determinant of real world outcome. Doing so highlights the need to supplement the measurement of psychosocial function using the GAF in clinical practice with functional measures that are more sensitive to deficits in social cognition.

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Motivation and its Relationship to Neurocognition, Social Cognition, and Functional Outcome in Schizophrenia

Cited by 185 publications

References 40 publications

Integrated Psychological Therapy: Effectiveness in Schizophrenia Inpatient Settings Related to Patients' Age

Integrated Psychological Therapy: Effectiveness in Schizophrenia Inpatient Settings Related to Patients' Age

The association of neurocognitive impairment with diminished expression and apathy in schizophrenia

Social dysfunction in schizophrenia: An investigation of the GAF scale's sensitivity to deficits in social cognition

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