Virtual reality assessment of functional capacity in the early course of schizophrenia: Associations with cognitive performance and daily functioning

Abstract

Aim: Computer-based virtual reality assessments of functional capacity have shown promise as a reliable and valid way to assess individuals with multi-episode schizophrenia. However, there has been little research utilizing this innovative approach with young patients who are in the early phase of schizophrenia. Methods: Outpatients in the early course of schizophrenia (n = 42) were compared to controls (n = 13) at cross-sectional study points. Patients were within 2 years of their first psychotic episode, were an average of 22.2 years old and had an average of 12.3 years of education. We used the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and the University of California, San Diego (UCSD) Performance-Based Skills Assessment-2 (UPSA-2) to assess functional capacity. The MATRICS Consensus Cognitive Battery (MCCB) and the Cognitive Assessment Interview (CAI) were the measures of cognitive functioning. The Global Functioning Scale: Role (GFS-R) and Social (GFS-S), and the Role Functioning Scale (RFS) were the measures of daily functioning. Results: Early course patients vs controls were slower (patient M = 830.41 seconds vs control M = 716.84 seconds; t = 3.0, P < .01) and committed more errors (patient M = 3.2 vs control M = 1.7 seconds, t = 2.9, P < .01) on the VRFCAT. Total time was significantly correlated with the UPSA (r = −0.66, P < .01), MCCB (r = −0.70, P < .01), CAI (r = −0.51, P < .01), and GFS role (r = −0.52, P <. 01) and social functioning (r = −0.43, P = .03). Conclusions: We extend previous findings to patients with first-episode schizophrenia. Virtual-reality-based performance was correlated with a standard test of functional capacity, indicating VRFCAT validity. Furthermore, correlations with cognitive functioning and occupational/school and social functioning indicate promise as a coprimary measure to track changes in response to treatment. K E Y W O R D S assessment neurocognition, cognitive assessment, daily functioning, first episode, functional capacity, MATRICS, schizophrenia, virtual reality

Computer‐based virtual reality assessment of functional capacity in primary psychosis

“…If a clinician's assessment of functional capacity could allow an accurate representation of the specific skills that an individual would need to perform in various daily life situations, that could provide a method of prediction and a target for treatment planning and intervention. This would have broad applicability, as we know that these functional capacity deficits are also present in the early course of psychotic illness, so they are not simply a consequence of an established primary psychosis 4 .…”

Measuring functional outcomes in schizophrenia in an increasingly digital world

“…Specifically developed for clinical trial use ( Keefe et al, 2016 ), the VRFCAT is now implemented to detect functionally meaningful improvements in clinical trials ( Nahum et al, 2020 ) and has been deployed in four clinical trials that started within the last year. It has demonstrated sensitivity to relevant deficits in patients with schizophrenia ( Keefe et al, 2016 ; Ventura et al, 2020 ) related to four different functional abilities: (1) checking for the availability of items to complete a recipe, (2) taking a bus, (3) shopping in a store, and (4) managing currency. Six alternate forms of each scenario limit practice effects, and can be adapted as necessary ( Keefe et al, 2016 ).…”

Virtual reality-based assessment and treatment of social functioning impairments in psychosis: a systematic review

“…In order to evaluate proposed indicators of social functioning, a vast number of measures were used across all the studies. Some studies assessed 'functional capacity' in a broad sense (Ventura et al, 2020), whilst others assessed more discrete indicators of social functioning. The most commonly assessed social functioning domains across the studies were emotion recognition, interpersonal distance, eye gaze, social interactions, social cognition/perception, facial cue/facial emotion recognition, and paranoia.…”

“…One study had a very large sample (N ¼ 333) and is likely to have more robust findings in terms of indicating the acceptability of the VR (Keefe et al, 2016). Studies found that clinical samples had impairments related to eye gaze (Bekele et al, 2017;Caruana et al, 2019), impaired theory of mind (Canty et al, 2017), performed more slowly and made more errors during recognition and interaction tasks (Ventura et al, 2020), had higher intimacy for distant avatars (Park et al, 2014), and especially had difficulties in emotion recognition and related facial and social cues (Berrada-Baby et al, 2016;Dyck et al, 2010;Gutierrez-Maldonado et al, 2012;Kim, Jung, et al, 2009;Kim et al, 2005;Kim et al, 2007;Marcos-Pablos et al, 2016;Song et al, 2015;Thirioux et al, 2014). At a neuroimaging level, studies found functional deficits in the mirror neuron system and dysfunction of the dorsolateral prefrontal cortex-superior temporal sulcus network (Kim, Jung, et al, 2009;Shin et al, 2015).…”