Dr. Harvey Replies

Abstract

Back to table of contents Previous article Next article Letters to the EditorFull AccessDr. Harvey RepliesPHILIP D. HARVEY Ph. D.,PHILIP D. HARVEY Ph. D.Search for more papers by this author,Published Online:1 Jun 2008https://doi.org/10.1176/appi.ajp.2008.08020229rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: Drs. Beck and Grant call to our attention the very important point that the influence of cognitive functioning on everyday outcomes is affected by the presence of defeatist attitudes. These attitudes have a mediating effect and supplement the influence of cognitive impairment in the prediction of everyday outcomes. Thus, competence (i.e., what one can do, such as cognitive performance) is only one of several predictors of real-world functional performance (i.e., what one actually does). In fact, we previously demonstrated that there are multiple competence domains of importance, including neuropsychological performance and the capacity to perform everyday living and social activities (i.e., functional capacity) (1) . Both of these competence variables were described in the three Measurement and Treatment Research to Improve Cognition in Schizophrenia articles discussed in our editorial. Although defeatist attitudes are clear mediators, there are other factors that may also mediate between neurocognitive functioning and everyday outcomes, including patients’ psychological characteristics (e.g., depression, motivational factors, social and cognitive abilities) as well as societal and individual factors (e.g., disability compensation, ethnicity). In the effort to account for everyday impairment in individuals with schizophrenia, it appears that a well-defined separation of competence, performance, and mediating factors will lead to the most distinct analysis of contributors to this impairment. These distinctions could result in important treatment implications, since pharmacological and psychosocial treatments are unlikely to affect all of the multiple influences on impairment equally, and they are unlikely to affect some of these influences at all. Atlanta, Ga.The author’s disclosures accompany the original article.This letter (doi: 10.1176/appi.ajp.2008.08020229r) was accepted for publication in March 2008.Reference1. Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD: Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry 2006; 163:418–425Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 165Issue 6 June, 2008Pages 772-772THE AMERICAN JOURNAL OF PSYCHIATRY June 2008 Volume 165 Number 6 Metrics PDF download History Published online 1 June 2008 Published in print 1 June 2008