title: Cascading and combined effects of cognitive deficits and residual symptoms on functional outcome in schizophrenia - A path-analytical approach.
abstract: Understanding the complex relationship among determinants of real-world functioning in schizophrenia patients in remission is important in planning recovery-oriented interventions. We explored two path-analytical models of functioning in schizophrenia. 170 Schizophrenia patients remitted from positive symptoms underwent fairly comprehensive assessments of cognition - neurocognition (NC) and social cognition (SC), residual symptoms - insight, motivation and other negative symptoms, and socio-occupational functioning. We explored (a) a cascading model, where NC predicted functional outcome through its effects on other determinants and (b) a combined model, incorporating additional direct paths from each of the determinants. The combined model, and not the cascading model demonstrated a good fit. Post-hoc trimming of the combined model by elimination of non-significant paths maintained the goodness-of-fit and was retained as the final model. In addition to the direct paths, this final model demonstrated that (a) NC influenced functioning through SC and insight and (b) SC influenced functioning through motivation and negative symptoms. This suggests that NC and SC may influence functional outcome directly, as well as indirectly, via specific impact on insight, and motivation and negative symptoms respectively.
authors.affiliation: Department of Psychiatry, Mandya Institute of Medical Sciences, Mandya 571401 India.
authors.forename: Haralahalli D
authors.initials: HD
authors.lastname: Bhagyavathi
authors.affiliation: Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India. Electronic address: urvakhsh@gmail.com.
authors.forename: Urvakhsh Meherwan
authors.initials: UM
authors.lastname: Mehta
authors.affiliation: Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
authors.forename: Jagadisha
authors.initials: J
authors.lastname: Thirthalli
authors.affiliation: Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
authors.forename: C Naveen
authors.initials: CN
authors.lastname: Kumar
authors.affiliation: Department of Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
authors.forename: J Keshav
authors.initials: JK
authors.lastname: Kumar
authors.affiliation: Department of Biostatistics, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
authors.forename: D K
authors.initials: DK
authors.lastname: Subbakrishna
authors.affiliation: Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
authors.forename: Bangalore N
authors.initials: BN
authors.lastname: Gangadhar
mesh_terms: D000293:Adolescent; D000328:Adult; D001364:Awareness; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D012559:Schizophrenia / Q000175:diagnosis* / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D012919:Social Behavior; D055815:Young Adult
keywords: Cognition; Disability; Insight; Motivation; Psychosis; Rehabilitation; Symptoms