Everyday action in schizophrenia: Performance patterns and underlying cognitive mechanisms.

Abstract

Everyday action is impaired among individuals with schizophrenia, yet few studies have characterized the nature of this deficit using performance-based measures. This study examined the performance of 20 individuals with schizophrenia or schizoaffective disorder on the Naturalistic Action Test (M. F. Schwartz, L. J. Buxbaum, M. Ferraro, T. Veramonti, & M. Segal, 2003). Performance was coded to examine overall impairment, task accomplishment, and error patterns and was compared with that of healthy controls (n = 28) and individuals with mild dementia (n = 23). Additionally, 2 competing accounts of everyday action deficits, the resource theory and an executive account, were evaluated. When compared with controls, the participants with schizophrenia demonstrated impaired performance. Relative to dementia patients, participants with schizophrenia obtained higher accomplishment scores but committed comparable rates of errors. Moreover, distributions of error types for the 2 groups differed, with the participants with schizophrenia demonstrating greater proportions of errors associated with executive dysfunction. This is the 1st study to show different Naturalistic Action Test performance patterns between 2 neurologically impaired populations. The distinct performance pattern demonstrated by individuals with schizophrenia reflects specific deficits in executive function.

Commissions and Omissions Are Dissociable Aspects of Everyday Action Impairment in Schizophrenia

“…Although Kessler et al (2007) reported a predominantly commissive error pattern in schizophrenia, which was associated with a characteristic executive impairment, omissions nonetheless occurred in this sample in association with global cognitive impairment, providing preliminary support for the omission-commission model. Analyses examining relations between a priori-defined components of everyday action performance (i.e., accuracy and efficiency) and neuropsychological measures have broadly supported associations between accuracy and processing Everyday action impairment in schizophrenia speed/working memory, and between efficiency and executive functions (e.g., planning, set-shifting; Rempfer et al, 2003;Zayat et al, 2011), further supporting the existence of distinct components of action impairment in schizophrenia.…”

“…and sensitivity to executive dysfunction in schizophrenia (Giovannetti et al, 2008;Iampietro et al, 2012;Kessler et al, 2007;Rempfer et al, 2003;Semkovska et al, 2004;Zayat et al, 2011).…”

“…We examined a range of errors made by individuals with schizophrenia on a performance-based test of everyday action, used PCA to reduce these errors to their principal components, and correlated resultant components with measures of global cognition and executive function. Given prior findings (Giovannetti et al, 2008Iampietro et al, 2012;Kessler et al, 2007;Rempfer et al, 2003;Zayat et al, 2011), we hypothesized the PCA would yield at least two components reflecting the omission-commission distinction. We predicted these components would be associated with distinct neuropsychological functions, with commissions relating to executive function and omissions relating to global cognition.…”

Everyday action planning in schizophrenia

“…Participants with SZ were recruited from extended-stay, inpatient units of two Philadelphia hospitals; participants on these units typically exhibit moderate-level cognitive deficits. Individuals were recruited if they were between the ages of 18 and 65 years and had a primary diagnosis of schizophrenia (N ¼ 36) or schizoaffective disorder (N ¼ 12) according to DSM-IV criteria (American Psychiatric Association, 1994) for a prior study on everyday action impairment (see Kessler et al, 2007). All participants were clinically diagnosed with schizophrenia or schizoaffective disorder by their treating psychiatrist on the inpatient unit.…”

“…Deficits in executive functioning are ubiquitous in this population (Barch et al, 2001;Barch & Smith, 2008;Elvevåg & Goldberg, 2000;Velligan & Bow-Thomas, 1999), with several studies reporting that people with schizophrenia show reliable differences from healthy controls on traditional neuropsychological tests of planning (Morice & Delahunty, 1996;Morris, Rushe, Woodruffe, & Murray, 1995;Staal, Hijman, Hulshoff, & Kahn, 2000). The extant literature also shows that cognitive deficits in schizophrenia are associated with reduced everyday functioning (Evans et al, 2003;Harvey, Green, Keefe, & Velligan, 2004;Kessler, Giovannetti, & MacMullen, 2007;Klapow et al, 1997;Patterson et al, 1998;Patterson, Goldman, McKibbin, Hughs, & Jeste, 2001;Semkovska, Bedard, Godbout, Limoge, & Stip, 2004;Semkovska, Stip, Godbout, Paquet, & Bedard, 2002;Sevy & Davidson, 1995;Velligan et al, 2007). However, the link between planning deficits and everyday functioning in schizophrenia has not been extensively studied.…”