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.

Duration of attenuated positive and negative symptoms in individuals at clinical high risk: Associations with risk of conversion to psychosis and functional outcome

“…Even after restricting the calculation of negative symptom duration by removing N1-Social Anhedonia, long-term negative symptoms were still adversely related to social functioning. This pattern is consistent with previous findings in adult patients with an established course of illness that have shown that negative symptoms are more related to social functioning than other aspects of everyday functional outcome (i.e., vocational outcomes), even when accounting for neurocognitive impairments (Leifker et al, 2009; Strassnig et al, 2015). Moreover, past findings from our group have shown that neurocognitive abilities are strongly related to role functioning at outcome, in particular verbal memory deficits (Carrión et al, 2013), further suggesting that certain deficits may be differentially related to specific domains of functioning at outcome.…”

Long-term employment among people at ultra-high risk for psychosis

“…Exploration of different domains of functioning is important as these may be differentially affected and deficits may be driven by different aspects of illness (Strassnig et al, 2015). Recent evidence in the UHR group suggests social and occupational functioning are dissociable domains that are not always correlated with one another (Cornblatt et al, 2007;Cotter et al, 2014Cotter et al, , 2015b.…”

Potential Role of Antipsychotic-Galantamine-Memantine Combination in the Treatment of Positive, Cognitive, and Negative Symptoms of Schizophrenia

“…In another meta-analysis of 8 RCTs ( n = 452) in schizophrenia, memantine improved cognition compared to placebo, with a weighted MD of 3.09 ( p < 0.00001) [43]. Improvements in negative symptoms, which are associated with functioning [44, 45], have also been shown with memantine. However, these findings should be taken with caution, as negative symptoms were measured with the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Syndrome Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS), which do not differentiate primary versus secondary negative symptoms, instead of the Schedule for the Deficit Syndrome [46], which does differentiate these symptoms.…”