The “Right Stuff” Revisited: What Have We Learned About the Determinants of Daily Functioning in Schizophrenia?: Fig. 1.

Abstract

It has been about 15 years since we published our article asking whether we are measuring the "Right Stuff" as we search for predictors and determinants of functional outcome in schizophrenia. At that time, we raised the question as to whether the neurocognitive assessments used to study outcome in schizophrenia were too narrow to capture the wide variability in factors that determine daily functioning. While the study of the determinants of functioning in schizophrenia has grown and matured, we are struck by 3 aspects of the article that evolved in different directions. First, the selection of outcome domains in the Right Stuff meta-analysis reflects a focus at that time on predictors of psychiatric rehabilitation. Second, expansion beyond traditional neurocognitive domains occurred in one suggested area (social cognition), but not another (learning potential). Third, the field has responded assertively to the recommendation to evaluate more informed and informative theoretical models.

Role of learning potential in cognitive remediation: Construct and predictive validity

“…LP has predicted treatment outcome incrementally above prediction by static factors in vocational rehabilitation (Sergi et al, 2005; Watzke et al, 2008; Watzke et al, 2009) and CR (Boosman et al, 2014; Wiedl & Wienobst, 1999). Previous research indicates that LP may not relate strongly to skills developed in the absence of related interventions (e.g., Green et al, 2015; Kurtz et al, 2010; Tenhula et al, 2007; Vaskinn et al, 2008). We suggest the utility of LP as a predictor of outcome will depend both on the capacity being assessed and the opportunity to develop that capacity through specific training.…”

“…These and other approaches of CR have been found generally efficacious for individuals with schizophrenia-spectrum disorders (SSD) (McGurk et al, 2007; Wykes et al, 2011), but substantial variability in treatment outcome within and between studies raises questions about what individual differences influence response to treatment (Radhakrishnan et al, 2015). In particular, little is known about how background characteristics related to learning capacity influence treatment outcome (Green et al, 2000; Green et al, 2015; Kurtz, 2012). Given the time- and labor-intensive nature of CR, there is value in identifying variables that predict treatment efficacy and that could be used to inform and personally tailor treatment.…”

“…The utility of LP assessment has been questioned in some cases due to limited relationship to functional status (Green et al, 2015), however, different methods of quantifying LP assessments have been shown to greatly influence their strength of association with other measures (Fiszdon & Johannesen, 2010). Thus, in determining the predictive utility of LP measures, one should also consider basic psychometric aspects of the derived LP score as well as construct validity with respect to outcome domain.…”

The 20-Year Longitudinal Trajectories of Social Functioning in Individuals With Psychotic Disorders

“…Finally, the findings across studies have been mixed in terms of how strongly social functioning is related to other daily life outcomes with results ranging from fairly weak to strong associations (20). …”

Psychopathological Symptoms Assessed by a System-Specific Approach Are Related to Global Functioning in Schizophrenic Disorders

“…Therefore, several recent studies focused on identifying predictors of poor functional outcome [2,3]. These predictors include pronounced negative symptoms, male gender, and a low educational level [4] as well as social and nonsocial cognitive impairment [5]. In this context, the distinction between positive and negative symptoms, which became popular in the 1980s, has been widely used to attempt to carve out psychopathological symptom patterns in schizophrenic disorders [6,7,8].…”