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The purpose of this study was to assess how neurocognition and social cognition were associated with initial functional level and with rates of functional change in intensive community-based psychosocial rehabilitation interventions that have been shown to yield significant functional change for individuals diagnosed with schizophrenia. We also examined how service intensity was associated with rates of change and whether it served as a moderator of the relationship between functional change and both neurocognition and social cognition. The sample consisted of 125 individuals diagnosed with schizophrenia or schizoaffective disorder who were recruited upon admission to 1 of 4 community-based psychosocial rehabilitation facilities and were followed prospectively for 12 months. One hundred and two subjects completed the 12-month protocol. The findings suggested that (i) the initial level of psychosocial functioning was related to both social cognition and neurocognition at baseline, (ii) when significant rehabilitative change occurs, higher neurocognition and social cognition scores at baseline predicted higher rates of functional change over the subsequent 12 months, (iii) greater service intensity was related to higher rates of improvement in functional outcome over time, and (iv) service intensity moderated the relationship between neurocognition and initial functional level and moderated the relationship between social cognition and the rates of functional change at a trend level. These findings have relevance to our understanding of the heterogeneity in functional rehabilitative outcomes, to our understanding of the conditions of rehabilitative change and for the design of psychosocial interventions in the community.

To address significant gaps in our understanding about how neurocognition, intrinsic motivation (IM), and psychosocial functioning are interrelated in schizophrenia, this study investigated the following questions: Is IM stable or dynamic over time? Does neurocognition predict change in IM over time? What is the association between change in neurocognition, change in IM, and change in psychosocial functioning? Finally, what is the causal structure of the relationships among neurocognition, IM, and psychosocial functioning over time? One hundred and thirty individuals diagnosed with schizophrenia or schizoaffective disorder were recruited from 4 community-based psychosocial rehabilitation programs in urban Los Angeles. Measures of neurocognition were taken at baseline and 12 months. Measures of IM, psychosocial functioning, and symptoms were taken at baseline, 6, and 12 months. Results of latent growth curve modeling analyses demonstrated that IM is dynamic over time. Baseline neurocognition was associated with the initial level of IM but did not predict the rate of change in motivation. However, baseline levels of IM predicted rates of subsequent improvement in neurocognition. Change in IM was strongly associated with change in psychosocial functioning, and change in neurocognition was associated with change in psychosocial functioning, but change in IM was not associated with change in neurocognition. Latent difference score analyses revealed that neurocognition caused changes in psychosocial functioning, and psychosocial functioning caused changes in IM. These findings improve our fundamental understanding of the relationships among these variables and contribute to intervention development for improving outcomes in schizophrenia.Key words: intrinsic motivation/neurocognition/ schizophrenia/psychosocial functioning/outcome/ rehabilitation IntroductionRecent studies indicate that neurocognition and intrinsic motivation (IM) have significant functional consequences for individuals with schizophrenia.1-8 Substantial research links aspects of neurocognition to functional outcomes in work, social, and independent living domains (for review, see Green et al ) and functional improvement during rehabilitation. 2,4,5 There is newer but also growing literature linking intrinsic and extrinsic motivation separately to functional outcomes and treatment responsiveness (eg, Choi and Medalia 6). There is also recent evidence that IM mediates the relationship between neurocognition and functional outcomes. 7,8 While knowledge is growing in this area, we lack a fundamental understanding of how these variables are interrelated. A prospective approach is essential to better understand the relationships among neurocognition, IM, and functional outcomes in schizophrenia. Longitudinal multiwave data will allow for an examination of the relationships among change in these variables over time as well as for modeling the causal relationships among them. This will contribute to understanding the relationships among these variables, as w...

Social cognition and neurocognition could have independent and distinct upward causal effects on functional outcome. It is also suggested that the approaches for remediation of neurocognition and social cognition might need to be distinct.

Objective: The purpose of the present study was to examine the cross-ethnic construct validity of the Brief Symptom Inventory (BSI). Method: The sample consisted of 1,166 individuals diagnosed with severe and persistent mental illness who were receiving treatment in community-based mental health programs. Multiple-group confirmatory factor analysis was used to test measurement invariance of the BSI's second-order factor model across three ethnic groups (African Americans, Caucasians, and Latinos). Results: The data supported the configural invariance of the BSI's second-order factor model as well as the full metric invariance and the partial metric invariance. Conclusions: The present study presented substantial empirical evidence for the construct validity of the BSI's second-order factor model across the three ethnic groups.Keywords: Brief Symptom Inventory (BSI); second-order factor; measurement invariance; people with severe and persistent mental illness (SPMI); confirmatory factor analysis 93