title: Self-assessment of functional ability in schizophrenia: milestone achievement and its relationship to accuracy of self-evaluation.
abstract: Between 50% and 80% of patients with schizophrenia do not believe they have any illness, and their self-assessment of cognitive impairments and functional abilities is also impaired compared to other information, including informant reports and scores on performance-based ability measures. The present article explores self-assessment accuracy in reference to real world functioning as measured by milestone achievement such as employment and independent living. Our sample included 195 people with schizophrenia examined with a performance-based assessment of neurocognitive abilities and functional capacity. We compared patient self-assessments across achievement of milestones, using patient performance on cognitive and functional capacity measures as a reference point. Performance on measures of functional capacity and cognition was better in people who had achieved employment and residential milestones. Patients with current employment and independence in residence rated themselves as more capable than those who were currently unemployed or not independent. However, individuals who had never had a job rated themselves at least as capable as those who had been previously employed. These data suggest that lifetime failure to achieve functional milestones is associated with overestimation of abilities. As many patients with schizophrenia never achieve milestones, their self-assessment may be overly optimistic as a result.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Gould
authors.forename: Samir
authors.initials: S
authors.lastname: Sabbag
authors.forename: Dante
authors.initials: D
authors.lastname: Durand
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Philip D
authors.initials: PD
authors.lastname: Harvey
mesh_terms: D000124:Achievement; D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000502:physiology; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis; D012565:Schizophrenic Psychology; D012647:Self-Assessment
references.citation: Psychiatr Clin North Am. 1998 Mar;21(1):27-42
references.pmid: 9551489
references.citation: J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
references.pmid: 9881538
references.citation: Am J Psychiatry. 2006 Mar;163(3):418-25
references.pmid: 16513862
references.citation: Schizophr Bull. 2013 Jan;39(1):102-11
references.pmid: 21765165
references.citation: J Neurotrauma. 2010 Jul;27(7):1195-202
references.pmid: 20380551
references.citation: Am J Psychiatry. 2006 Mar;163(3):411-7
references.pmid: 16513861
references.citation: Am J Psychiatry. 2010 Sep;167(9):1116-24
references.pmid: 20478878
references.citation: Soc Work Res Abstr. 1983 Fall;19(3):9-21
references.pmid: 10264257
references.citation: Schizophr Res. 2010 May;118(1-3):134-9
references.pmid: 19840898
references.citation: Schizophr Bull. 2011 Mar;37(2):334-43
references.pmid: 19525354
references.citation: Organ Behav Hum Decis Process. 2008 Jan 1;105(1):98-121
references.pmid: 19568317
references.citation: Psychiatry (Edgmont). 2010 Feb;7(2):41-4
references.pmid: 20376275
references.citation: Schizophr Res. 2012 May;137(1-3):147-50
references.pmid: 22316568
references.citation: Schizophr Bull. 2008 Nov;34(6):1221-30
references.pmid: 18199632
references.citation: J Pers Soc Psychol. 1991 Oct;61(4):521-32
references.pmid: 1960645
references.citation: Psychiatry Res. 2005 Jul 15;136(1):43-50
references.pmid: 16024090
references.citation: Schizophr Bull. 2007 Nov;33(6):1364-72
references.pmid: 17341468
references.citation: Am J Psychiatry. 2011 Nov;168(11):1195-201
references.pmid: 21572166
references.citation: Am J Psychiatry. 2007 Mar;164(3):437-41
references.pmid: 17329468
references.citation: J Psychiatr Res. 2007 Dec;41(12):1012-8
references.pmid: 17014866
references.citation: Schizophr Res. 2011 Sep;131(1-3):250-5
references.pmid: 21620682
references.citation: Schizophr Res. 2009 Feb;107(2-3):275-85
references.pmid: 19013769
references.citation: J Psychiatr Res. 2008 Mar;42(4):320-7
references.pmid: 17303168
references.citation: Schizophr Bull. 2007 Sep;33(5):1138-48
references.pmid: 17493956
references.citation: Am J Psychiatry. 2008 Feb;165(2):203-13
references.pmid: 18172019
references.citation: Neurosci Biobehav Rev. 2011 Jan;35(3):573-88
references.pmid: 20620163
references.citation: Schizophr Res. 2009 Nov;115(1):82-7
references.pmid: 19775869
references.citation: Schizophr Bull. 1984;10(3):388-98
references.pmid: 6474101
references.citation: Am J Psychiatry. 2006 Mar;163(3):426-32
references.pmid: 16513863
references.citation: Biol Psychiatry. 2008 Mar 1;63(5):505-11
references.pmid: 17662256
references.citation: J Psychiatr Res. 2012 Dec;46(12):1546-52
references.pmid: 22979993
references.citation: J Exp Psychol Gen. 1979 Dec;108(4):441-85
references.pmid: 528910
references.citation: Schizophr Bull. 2002;28(2):249-57
references.pmid: 12693431
references.citation: Arch Gen Psychiatry. 1994 Oct;51(10):826-36
references.pmid: 7944872
references.citation: J Nerv Ment Dis. 2004 Jun;192(6):405-13
references.pmid: 15167403
references.citation: Schizophr Res. 2011 Nov;132(2-3):165-70
references.pmid: 21843926
references.citation: Schizophr Res. 2012 May;137(1-3):190-5
references.pmid: 22386735
references.citation: J Int Neuropsychol Soc. 2005 Sep;11(5):574-83
references.pmid: 16212684