Cognitive Performance and Long-Term Social Functioning in Psychotic Disorder: A Three-Year Follow-Up Study

Claudia J P Simons,Agna A Bartels-Velthuis,Gerdina H M Pijnenborg,Ruud Van Winkel

doi:10.1371/journal.pone.0151299

Abstract

ObjectiveStudies have linked cognitive functioning to everyday social functioning in psychotic disorders, but the nature of the relationships between cognition, social cognition, symptoms, and social functioning remains unestablished. Modelling the contributions of non-social and social cognitive ability in the prediction of social functioning may help in more clearly defining therapeutic targets to improve functioning.MethodIn a sample of 745 patients with a non-affective psychotic disorder, the associations between cognition and social cognition at baseline on the one hand, and self-reported social functioning three years later on the other, were analysed. First, case-control comparisons were conducted; associations were subsequently further explored in patients, investigating the potential mediating role of symptoms. Analyses were repeated in a subsample of 233 patients with recent-onset psychosis.ResultsInformation processing speed and immediate verbal memory were stronger associated with social functioning in patients than in healthy controls. Most cognition variables significantly predicted social functioning at follow-up, whereas social cognition was not associated with social functioning. Symptoms were robustly associated with follow-up social functioning, with negative symptoms fully mediating most associations between cognition and follow-up social functioning. Illness duration did not moderate the strength of the association between cognitive functioning and follow-up social functioning. No associations were found between (social) cognition and follow-up social functioning in patients with recent-onset psychosis.ConclusionsAlthough cognitive functioning is associated with later social functioning in psychotic disorder, its role in explaining social functioning outcome above negative symptoms appears only modest. In recent-onset psychosis, cognition may have a negligible role in predicting later social functioning. Moreover, social cognition tasks may not predict self-reported social functioning.

Highlights

Information processing speed and immediate verbal memory were stronger associated with social functioning in patients than in healthy controls
Symptoms were robustly associated with follow-up social functioning, with negative symptoms fully mediating most associations between cognition and follow-up social functioning
Cognitive functioning is associated with later social functioning in psychotic disorder, its role in explaining social functioning outcome above negative symptoms appears only modest

Summary

Introduction

There is some variability in the literature, most studies suggest psychotic disorder is characterized by a stable, diminished performance on the majority of cognitive domains [1,2], which presents itself before the onset of psychosis, and becomes more pronounced around the first psychotic episode, so that cognitive performance drops from approximately 0.5 SD below the healthy control mean in the prodromal stage to 1 to 2 SD below the healthy control mean in the first episode [3,4]. The cognitive deficits associated with psychotic disorders are linked to everyday social functioning and may limit the rate of functional improvement [5]. Cognitive abilities [6] and social cognitive skills [7,8] are consistently associated with various domains of social functioning. Research suggests that cognitive abilities may have bottom-up causal influences on the acquisition of social or living skills and on the deployment of these skills in the real world [9] which influence social cognition, which in turn may influence social functioning [10,11]. Accumulating evidence supports the suggestion that social cognition may be a mediating link between cognition and social functioning

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