title: Determinants of different aspects of everyday outcome in schizophrenia: The roles of negative symptoms, cognition, and functional capacity.
abstract: Cognition, negative symptoms, and depression are potential predictors of disability in schizophrenia. We present analyses of pooled data from four separate studies (all n>169; total n=821) that assessed differential aspects of disability and their potential determinants. We hypothesized that negative symptoms would predict social outcomes, but not vocational functioning or everyday activities and that cognition and functional capacity would predict vocational functioning and everyday activities but not social outcomes. The samples were rated by clinician informants for their everyday functioning in domains of social and vocational outcomes, and everyday activities, examined with assessments of cognition and functional capacity, rated clinically with the Positive and Negative Syndrome Scale (PANSS) and self-reporting depression. We computed a model that tested the hypotheses described above and compared it to a model that predicted that negative symptoms, depression, cognition, and functional capacity had equivalent influences on all aspects of everyday functioning. The former, specific relationship model fit the data adequately and we subsequently confirmed a similar fit within all four samples. Analyses of the relative goodness of fit suggested that this specific model fit the data better than the more general, equivalent influence predictor model. We suggest that treatments aimed at cognition may not affect social functioning as much as other aspects of disability, a finding consistent with earlier research on the treatment of cognitive deficits in schizophrenia, while negative symptoms predicted social functioning. These relationships are central features of schizophrenia and treatment efforts should be aimed accordingly.
authors: University of Miami Miller School of Medicine, United States.
authors: Martin T
authors: MT
authors: Strassnig
authors: Michigan State University, United States.
authors: Tenko
authors: T
authors: Raykov
authors: Genentech, Inc., United States.
authors: Cedric
authors: C
authors: O'Gorman
authors: Queen's University, Kingston, Ontario, Canada.
authors: Christopher R
authors: CR
authors: Bowie
authors: University of Miami Miller School of Medicine, United States.
authors: Samir
authors: S
authors: Sabbag
authors: University of Miami Miller School of Medicine, United States.
authors: Dante
authors: D
authors: Durand
authors: USCD Medical Center, United States.
authors: Thomas L
authors: TL
authors: Patterson
authors: University of Texas at Dallas, United States.
authors: Amy
authors: A
authors: Pinkham
authors: University of North Carolina at Chapel Hill, United States; Australian Catholic University, Melbourne, Victoria, Australia.
authors: David L
authors: DL
authors: Penn
authors: University of Miami Miller School of Medicine, United States; Research Service, Bruce W. Carter VA Miami Healthcare System, United States. Electronic address: philipdharvey1@cs.com.
authors: Philip D
authors: PD
authors: Harvey
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology*; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D012917:Social Adjustment
keywords: Cognition; Functional capacity; Negative symptoms; Schizophrenia; Social functioning