The course and correlates of everyday functioning in schizophrenia

Abstract

Previously institutionalized older patients with schizophrenia show changes in cognitive and functional capacity over time. This study examined changes in real-world functioning in a sample of people with schizophrenia who varied in their history of long-term institutionalization and related changes in real world functioning to changes in cognition and functional capacity over the follow-up period. Older patients with schizophrenia (n=111) were examined with assessments of cognitive functioning, functional capacity, clinical symptoms, and everyday functioning. They were then followed up to 45 months and examined up to two times. Mixed-model regression was used to examine changes in real-world functioning in social, everyday living, and vocational domains over the follow-up period and identify potential predictors of change. Everyday functioning worsened over time in all three domains. Although length of longest hospitalization predicted worsening, this influence was eliminated when the course of functional capacity was used to predict the course of everyday functioning. For both vocational and everyday living domains, as well as the composite score on functional status, worsening in performance based measures of everyday functioning and social competence predicted worsening in real world functioning. Changes in negative symptoms further predicted worsening in the everyday living domain. Worsening in everyday functioning is found in people with schizophrenia and those with a history of greater chronicity and severity of illness seem more affected. These influences seem to be expressed through worsening in the ability to perform everyday functional skills. Potential causes of these changes and implications for reducing these impairments are discussed.

Comparison of social functioning in community‐living older individuals with schizophrenia and bipolar disorder: a catchment area‐based study

“…We did not exclude ‘recovered’ patients, in contrast to the studies of Reichenberg et al . () and Harvey et al . ().…”

“…We found that age was not a predictor of social functioning in this cross‐sectional study, while previous longitudinal studies found a decline in social functioning over time in schizophrenia (Harvey et al ., ; Reichenberg et al ., ; Kalache et al ., ). We did not exclude ‘recovered’ patients, in contrast to the studies of Reichenberg et al .…”

“…Age has been negatively associated with social functioning in adults with bipolar disorder (Guttierrez-Rojas et al, 2010), suggesting that social functioning may further decline in older patients with bipolar disorder. This may also be the case in schizophrenia, were cognitive functioning, social skills and everyday functioning decline over time (Loewenstein et al, 2012;Reichenberg et al, 2014). Lower cognitive functioning, more negative symptoms and a history of a long institutional stay are factors that are associated with a decrease in everyday functioning in late-life schizophrenia (Harvey et al, 2010;Reichenberg et al, 2014;Kalache et al, 2015).…”

Cluster analysis differentiates high and low community functioning in schizophrenia: Subgroups differ on working memory but not other neurocognitive domains

“…However, clinical stabilization with pharmacotherapy explains minimal variation in community functioning (Tandon et al, 2010). While some studies suggest that both neurocognitive and social cognitive processes facilitate improved community functioning (Brekke et al, 2005;Leifker et al, 2009), others suggest that social cognition is a more proximal treatment target than neurocognition (Fett et al, 2011;Reichenberg et al, 2014). Yet other studies suggest that neurocognitive deficits predict poorer community functioning independently from social cognition (Hofer et al, 2011).…”

Social and non‐social measures of cognition for predicting self‐reported and informant‐reported functional outcomes in early psychosis

“…Thus, it logically follows that difficulties in this domain may affect the development of skill acquisition necessary for community functioning. The clinical correlates of the capacity‐based measures support previous findings that suggest that negative symptoms may make specific additional contributions to informant‐rated community functioning (Bowie, Leung, Reichenberg et al ., ; Reichenberg, Feo, Prestia, Bowie, Patterson & Harvey, ). Although the results from this study are correlational and cross‐sectional, they indicate that community functioning is affected by a complex relationship between non‐social and social‐cognitive domains, and that this relationship may be further impacted by negative symptoms.…”