Stability and change in symptoms, cognition, and community outcome in schizophrenia.
It has been well established that neurocognitive deficits are a core feature in schizophrenia and predict difficulties in functional independence. However, few studies have assessed the longitudinal stability of cognition and key aspects of functional outcome concurrently. Even less attention has been directed at the contingency of cognitive change on real world outcome changes. Accordingly, this study will assess the extent to which significant changes in cognition and community status are independent or related. As a point of comparison, the stability of clinical symptom status and the relationship between symptom and outcome change are evaluated. Symptoms, cognitive abilities, and community outcome was assessed in 128 patients with schizophrenia at baseline and again one year later. Intraclass correlation coefficients were used to index stability and reliable change index analyses quantified the prevalence of significant improvement or deterioration in each of the three illness features. Results from these analyses revealed that symptom status, cognitive functioning, and community outcome are similarly stable in treated schizophrenia outpatients. A small proportion of the sample demonstrated significant improvement or deterioration in these domains, with only weak evidence that such change was predicted by changes in symptoms or cognition. Further, there was no strong evidence of a preferential relationship for cognition relative to symptoms in relation to functional outcome. These results shed light on the strength and nature of the cognition-real world outcome relationship in schizophrenia and have implications for pharmacological and behavioral interventions aimed at improving real world outcome.
Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada. Electronic address: amiles@yorku.ca.
Ashley A
AA
Miles
Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada. Electronic address: walterh@yorku.ca.
R Walter
RW
Heinrichs
Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada. Electronic address: ammarina@yorku.ca.
Narmeen
N
Ammari
Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada. Electronic address: lhartman@yorku.ca.
Leah
L
Hartman
Cleghorn Program (Early Intervention in Psychosis & Psychotic Disorders Clinic), St. Joseph's Healthcare, 25 Charlton Ave East, Suite 703, Hamilton, Ontario L8N 1Y2, Canada; Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton Ontario L8S 4L8, Canada. Electronic address: smcdermi@stjosham.on.ca.
Stephanie
S
McDermid Vaz
Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada. Electronic address: evarsm@yorku.ca.
Eva
E
Muharib
D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012111:Residence Characteristics; D012559:Schizophrenia / Q000150:complications* / Q000453:epidemiology*; D012565:Schizophrenic Psychology
Change; Cognition; Functional outcome; Schizophrenia; Stability; Symptoms