Foresight in Schizophrenia: A Potentially Unique and Relevant Factor to Functional Disability

Abstract

The factors that contribute to functional disability in schizophrenia are only partially known and likely consist of an array of biopsychosocial constructs. This research sought to further elucidate the factors that conspire against functional recovery from schizophrenia by introducing the concept of foresight and exploring its unique contribution to functional outcome. Patients in the early course of schizophrenia or schizoaffective disorder were studied over the course of one year as part of a clinical trial of cognitive enhancement therapy. Fifty-eight patients were assessed by using measures of foresight, functional disability, neurocognitive function, and psychopathology at baseline, and 49 were reassessed on the aforementioned domains at the one-year follow-up. Patients displayed significant deficits in foresightfulness throughout the study period. Cross-sectionally, measures of foresight exhibited significant and moderate to large relationships with measures of functional disability at both baseline and the one-year follow-up. Longitudinal analyses revealed that baseline levels of foresight were significantly predictive of future functional disability, after adjusting for neurocognitive function, psychopathology, and treatment assignment. This exploratory investigation suggests that foresight may be an important determinant of functional disability in schizophrenia. Future research will need to investigate whether impairments within this domain can be remediated to help promote a more functional recovery from the disorder.