title: Social dysfunction in schizophrenia: an investigation of the GAF scale's sensitivity to deficits in social cognition.
abstract: 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<.001). While neuropsychological performance explained a further 4.7% of variation (r(2)change = .047, Fchange (1, 187) = 12.63, p<.001), social cognition did not explain any further variance in functioning (r(2)change = .006, Fchange (1, 186) = 1.63, p = .20).
  
  
  CONCLUSIONS
  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.
authors: Department of Psychiatry & Neuropsychiatric Genetics Research Group, School of Medicine & Trinity College Institute of Neuroscience, The Trinity Center, St James's Hospital, Dublin 8, Ireland.
authors: Deirdre A
authors: DA
authors: Robertson
authors: April
authors: A
authors: Hargreaves
authors: Eric B
authors: EB
authors: Kelleher
authors: Derek
authors: D
authors: Morris
authors: Michael
authors: M
authors: Gill
authors: Aiden
authors: A
authors: Corvin
authors: Gary
authors: G
authors: Donohoe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012559:Schizophrenia / Q000150:complications; D012565:Schizophrenic Psychology; D012680:Sensitivity and Specificity; D012920:Social Behavior Disorders / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult