Functional Capacity In Schizophrenia Research Articles

The Impact of Poor Nonverbal Social Perception on Functional Capacity in Schizophrenia.

BackgroundNonverbal social perception is the ability to interpret the intentions and dispositions of others by evaluating cues such as facial expressions, body movements, and emotional prosody. Nonverbal social perception plays a key role in social cognition and is fundamental for successful social interactions. Patients with schizophrenia have severe impairments in nonverbal social perception leading to social isolation and withdrawal. Collectively, these aforementioned deficits affect patients’ quality of life. Here, we compare nonverbal social perception in patients with schizophrenia and controls and examine how nonverbal social perception relates to daily functioning.MethodsWe compared nonverbal social perception in 41 stable outpatients with schizophrenia and 30 healthy controls using the Mini Profile of Nonverbal Sensitivity (Mini-PONS). The participants evaluated 64 video clips showing a female actor demonstrating various nonverbal social cues. Participants were asked to choose one of two options that best described the observed scenario. We correlated clinical ratings (Positive and Negative Syndrome Scale, Brief Negative Syndrome Scale), Self-report of Negative Symptoms, and functional assessments (functional capacity and functional outcome) with Mini-PONS scores.ResultsPatients performed significantly poorer in the Mini-PONS compared to controls, suggesting deficits in nonverbal social perception. These deficits were not associated with either positive symptoms or negative symptoms (including self-report). However, impaired nonverbal social perception correlated with distinctive domains of BNSS (mainly avolition and blunted affect), as well as functional capacity and functional outcome in patients.ConclusionWe demonstrate that nonverbal social perception is impaired in stable outpatients with schizophrenia. Nonverbal social perception is directly related to specific negative symptom domains, functional capacity and functional outcome. These findings underline the importance of nonverbal social perception for patients’ everyday life and call for novel therapeutic approaches to alleviate nonverbal social perception deficits.

Cognitive function mediates the relationship between visual contrast sensitivity and functional outcome in schizophrenia

BackgroundIndividuals with schizophrenia exhibit deficits in visual contrast processing, though less is known about how these deficits impact neurocognition and functional outcomes. This study investigated effects of contrast sensitivity (CS) on cognition and capacity for independent living in schizophrenia. Methods: Participants were 58 patients with schizophrenia (n = 49) and schizoaffective disorder (n = 9). Patients completed a psychophysical paradigm to obtain CS with stimuli consisting of grating patterns of low (0.5 and 1 cycles/degree) and high spatial frequencies (4, 7, 21 cycles/degree). Patients completed the MATRICS Consensus Cognitive Battery and Wechsler Adult Intelligence Scales, Third Edition to assess cognition, and the problem-solving factor of the Independent Living Scales to assess functional capacity. We computed bivariate correlation coefficients for all pairs of variables and tested mediation models with CS to low (CS–LSF) and high spatial frequencies (CS–HSF) as predictors, cognitive measures as mediators, and capacity for independent living as an outcome. Results: Cognition mediated the relationship between CS and independent living with CS–LSF a stronger predictor than CS–HSF. Mediation effects were strongest for perceptual organization and memory-related domains. In an expanded moderated mediation model, CS–HSF was found to be a significant predictor of independent living through perceptual organization as a mediator and CS–LSF as a moderator of this relationship. Conclusion: CS relates to functional capacity in schizophrenia through neurocognition. These relationships may inform novel visual remediation interventions.

Factor structure of cognitive performance and functional capacity in schizophrenia: Evidence for differences across functional capacity measures

BackgroundCognition and functional capacity predict functional outcomes in mental illness. Traditional approaches conceptualize cognition as comprised of domains, but many studies support a unifactorial structure. Some functional capacity measures may share a single-factor structure with cognition. In this study, we examined the factor structure of two measures of functional capacity, a conventional assessment and a newer computerized assessment, testing for a shared factor structure with cognition. MethodsPatients with schizophrenia and healthy controls were examined with the MATRICS Consensus Cognitive Battery (MCCB), the UCSD Performance Based Skills Assessment (UPSA), and the Virtual Reality Functional Capacity Assessment Tool (VRFCAT). Models of the factor structures of the MCCB, UPSA, and VRFCAT were calculated, as were correlations between MCCB scores and individual VRFCAT objectives. ResultsThe MCCB, VRFCAT, and UPSA all had unifactorial structures. The best fitting model of the correlations between MCCB and UPSA was a shared single factor, while the best fit for the relationship between MCCB and VRFCAT had two factors. Correlations between the MCCB domain and composite scores and the VRFCAT objectives suggested global rather than specific patterns of correlation. DiscussionThe relationship between cognitive performance and functional capacity was found to vary across functional capacity assessments. The UPSA and MCCB were not differentiated into separate factors, suggesting that the UPSA may overlap with neurocognitive performance. However, the VRFCAT appears to measure functional abilities that are separable from, yet correlated with, neurocognitive performance. It may provide a more distinctive assessment of the functional capacity construct.

M106. VIRTUAL-REALITY COGNITIVE TRAINING AND ASSESSMENT IN SCHIZOPHRENIA

BackgroundIt is widely accepted that neurocognitive performance is linked to functional outcomes in schizophrenia (Green, Kern, Braff, & Mintz, 2000). Research, however, shows that this relationship is likely to be mediated by other factors such as social competence (Brekke, Kay, Lee, & Green, 2005). Indeed, performance on cognitive tasks only explain 20% of the variance in work related skills (Bowie et al., 2008). Furthermore, the composite score generated by the gold standard neurocognitive measure, the MATRICS Consensus Cognitive Battery (MCCB), fails to predict work or education related functioning and independent living (August, Kiwanuka, McMahon, & Gold, 2012). To address these limitations, we developed a novel and ecologically valid virtual reality (VR) task with the aim to simultaneously measure cognition and functional capacity in schizophrenia. The assessment is set in a minimarket environment where participants are required to buy selected items from a shopping list. In this study, our objective was to establish the construct validity of the VR task in relation to the MCCB, and test whether it can predict functional outcomes. In addition, we tested whether app-based cognitive training can improve cognition and/or functional outcomes at follow-up as an exploratory objective.MethodsThirty patients with a diagnosis of schizophrenia or schizoaffective disorder were recruited from South London. At baseline, participants completed the VR task and MCCB, the Positive and Negative Syndrome Scale (PANSS), and various functional capacity/outcome measures including the Global Assessment of Functioning (GAF), Social and Occupational Functioning Assessment Scale (SOFAS), UCSD Performance-Based Skills Assessment-Brief (UPSA-B), and World Health Organization Disability Assessment Schedule II (WHODAS-II). A subset of participants was randomly allocated to receive a 4-week long, app-based training; either playing with an immersive or a 2D spatial memory training game. Those who completed the training were invited back for a follow-up visit. Construct validity of the VR task will be assessed through a series of bivariate correlations. The predictive ability of the VR task for functional outcomes will be tested through linear regression models. Finally, the efficacy of spatial memory training will be assessed using repeated measures ANOVA.ResultsData analysis is currently ongoing, and results will be presented at the conference.DiscussionThis study will provide the first indication whether VR can be employed to test cognition and functional capacity simultaneously in patients with schizophrenia. Given the current lack of reliable and ecologically valid functional outcome measures, new assessments that are sensitive to clinically meaningful cognitive improvements are desperately needed.

Blood perfusion in left inferior and middle frontal gyrus predicts communication skills in schizophrenia

Schizophrenia is one of the most debilitating mental disorders, severely affecting patients’ community functioning. Functional capacity (FC) describes the skills necessary for successful functional outcome (FO), such as financial knowledge or communication skills. We investigated whether resting-state cerebral blood flow (rCBF) measured at baseline with arterial spin labeling (ASL) would predict FC or FO at a 6-months follow-up in 27 schizophrenia patients. A negative linear association was noted between FC and rCBF in the left inferior and middle frontal gyrus, areas involved in language processing, suggesting a potential relationship between cerebral perfusion and prospective FC in schizophrenia.

Effect of Transcranial Direct Current Stimulation on Functional Capacity in Schizophrenia: A Study Protocol for a Randomized Controlled Trial.

UMIN000028224; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000032305.

176.3 Elevated Brain Lactate and Glutamine/glutamate in Schizophrenia: A 7T MRS Study

Background: Mitochondrial and bioenergetic alterations may play a role in the pathophysiology of schizophrenia, either directly or via alterations in underlying neurotransmitter systems. Postmortem, preclinical, cerebrospinal fluid, and 31P-magnetic resonance spectroscopy (MRS) studies provide some support. A recent 31P magnetization transfer MRS study found reduced creatine kinase reaction rate and pH in schizophrenia, consistent with dysfunctional glucose metabolism and the accumulation of lactate. This study tested the hypothesis that abnormal glycolysis leads to elevated lactate concentrations in subjects with schizophrenia. The high sensitivity of 7T MRS was used to measure brain lactate levels in vivo. The glutamatergic metabolites were also examined with the prediction that glutamine to glutamate (Gln/Glu) ratio would be higher in schizophrenia. Methods: Thirty-one controls and 29 participants with schizophrenia completed the study. MRS scanning was conducted on a Philips “Achieva” 7T scanner, and spectra were acquired from a voxel in the anterior cingulate cortex using STEAM (TE/TM/TR=14/33/3000 ms, 128 NEX, and 16 NEX water). Patients were assessed for psychiatric symptom severity, and all participants completed the MATRICS Consensus Cognitive Battery (MCCB) for general cognitive function and UCSD Performance-Based Skills Assessment (UPSA) for functional capacity. The relationship between lactate, psychiatric symptom severity, MCCB, and UPSA were examined. Results: Lactate was significantly higher in patients compared to controls (P = .045). Higher lactate was associated with lower general cognitive function (r = −.36, P = .01) and functional capacity (r = −.43, P = .001). The glutamine to glutamate ratio (Gln/Glu) was higher in patients compared to controls (P = .021). Similar to lactate, higher Gln/Glu was significantly related to lower general cognitive function (r = −.4, P = .004) and functional capacity (r = −.45, P = .001). Conclusion: This is the first study to report elevated in vivo anterior cingulate lactate levels in schizophrenia. Anterior cingulate Gln–Glu ratio was also higher in schizophrenia, which is consistent with previous reports. The results support the hypothesis that brain bioenergetics are altered in schizophrenia reflecting inefficient or diminished aerobic metabolism and a shift towards anaerobic metabolism. Elevated lactate may prove to be a useful biomarker of cognitive and functional capacity in schizophrenia. Interventions to promote more efficient mitochondrial energy metabolism may prove useful for enhancing cognition and alleviating functional impairments in schizophrenia.

Frontal slow-wave activity as a predictor of negative symptoms, cognition and functional capacity in schizophrenia.

Increased temporal and frontal slow-wave delta (1-4 Hz) and theta (4-7 Hz) activities are the most consistent resting-state neural abnormalities reported in schizophrenia. The frontal lobe is associated with negative symptoms and cognitive abilities such as attention, with negative symptoms and impaired attention associated with poor functional capacity. To establish whether frontal dysfunction, as indexed by slowing, would be associated with functional impairments. Eyes-closed magnetoencephalography data were collected in 41 participants with schizophrenia and 37 healthy controls, and frequency-domain source imaging localised delta and theta activity. Elevated delta and theta activity in right frontal and right temporoparietal regions was observed in the schizophrenia v. In schizophrenia, right-frontal delta activity was uniquely associated with negative but not positive symptoms. In the full sample, increased right-frontal delta activity predicted poorer attention and functional capacity. Our findings suggest that treatment-associated decreases in slow-wave activity could be accompanied by improved functional outcome and thus better prognosis.

Lurasidone Effects on Cognition and Functional Capacity in Schizophrenia

Lurasidone Effects on Cognition and Functional Capacity in Schizophrenia

A case control study of association between cognition and functional capacity in schizophrenia

BackgroundCognitive functions are important prognostic factors for schizophrenia (SZ), while ability to perform activities of daily living are important measures of functional capacity. The relationship between cognition and functional capacity has not been tested extensively in India. ObjectiveTo compare persons with SZ with controls on measures of cognition and functional capacity, and evaluate correlations between cognitive performance and functional capacity. MethodSchizophrenia outpatients and controls without psychiatric illness (DSM IV) who completed the MATRICS Consensus Cognitive Battery and Functional Assessment Battery comprised of two tests from University of California San Diego (UCSD) Performance Based Skill Assessment (UPSA), one Test of Adaptive Behavior in Schizophrenia (TABS) and one test from University of California San Diego Performance Based Skill Assessment Brief edition (UPSA-B). Cognitive and functional domains were examined using regression analyses, with relevant covariates. ResultsCases (N=51) though younger, were more educated than controls (N=41). Adjusting for education, controls performed better than cases in 3/7 cognitive and 4/5 domains of functional capacity but similarly in ‘household management’. Among both cases and controls, cognitive measures of verbal learning and speed of processing overlapped with functional capacity (3 domains). Working memory was associated with one functional domain. ConclusionsConsistent with other studies, Indian patients with schizophrenia performed worse than controls on several domains of cognition and functional capacity; these domains were correlated. Speed of processing and verbal learning are most frequently associated with functional capacity indices and should be targeted to improve skills of daily living among persons with SZ.

Improving the understanding of the link between cognition and functional capacity in schizophrenia and bipolar disorder

ObjectiveDeficits in cognitive functioning are related to functional disability in people with serious mental illness. Measures of functional capacity are commonly used as a proxy for functional disabilities for cognitive remediation programs, and robust linear relationships between functional capacity and cognitive deficits are frequently observed. This study aimed to determine whether a curvilinear relationship better approximates the association between cognitive functioning and functional capacity. MethodTwo independent samples were studied. Study 1: participants with schizophrenia (n=435) and bipolar disorder (n=390) aged 18–83 completed a neuropsychological battery and a performance-based measure of functional capacity. Study 2: 205 participants with schizophrenia (age range=39–72) completed a brief neuropsychological screening battery and a performance-based measure of functional capacity. For both studies, linear and quadratic curve estimations were conducted with cognitive performance predicting functional capacity scores. ResultsSignificant linear and quadratic trends were observed for both studies. Study 1: in both the schizophrenia and bipolar participants, when cognitive composite z-scores were >0 (indicating normal to above normal performance), cognition was not related to functional capacity. Study 2: when neuropsychological screening battery z-scores were >−1 (indicating low average to average performance), cognition was not related to functional capacity. ConclusionsThese results illustrate that in cognitively normal adults with serious mental illness, the relationship between cognitive function and functional capacity is relatively weak. These findings may aid clinicians and researchers determine who may optimally benefit from cognitive remediation programs, with greater benefits possibly being achieved for individuals with cognitive deficits relative to individuals with normal cognition.

UPSA-M: Feasibility and initial validity of a mobile application of the UCSD Performance-Based Skills Assessment

ObjectiveThis study aimed to develop and validate a tablet mobile application version of the UCSD Performance-Based Skills Assessment (UPSA-M), a widely used test for assessing functional capacity in schizophrenia and other neurocognitively impaired patient populations. MethodsThe UPSA-M was developed for an iPad platform. Twenty-one middle-aged and older adults with schizophrenia and 13 healthy comparison (HC) participants completed a brief iPad tutorial, followed by the UPSA-M (full version, which includes all components of Brief UPSA-M) and a computer usage questionnaire. During a separate visit, patients with schizophrenia and HC participants completed the Brief UPSA (UPSA-B), and patients with schizophrenia completed a symptom inventory and brief neuropsychological screening battery. ResultsThe UPSA-M was feasible for use among middle aged and older adults with schizophrenia with no prior history of tablet usage. The UPSA-M was able to differentiate between schizophrenia and HC participants 80% of the time, and this differential ability increased to 87% with the UPSA-M Brief. Traditional UPSA scores, UPSA-B scores, and neuropsychological performance were related to UPSA-M scores, whereas symptoms of psychopathology, experience with tablet technology, or difficulties operating the device were not significantly associated with UPSA-M. ConclusionsThe UPSA-M performed just as well as the standard-of-practice version. These preliminary results indicate that the UPSA-M Brief has greater sensitivity than the full version of the UPSA-M, and carries the advantage of a shorter administration time. Overall, the UPSA-M appears to be a promising mobile tool to assess functional capacity.

Cognitive Performance as a Predictor of Functional Capacity in Schizophrenia

Introduction: Schizophrenia is a severe mental illness characterized by cognitive deficits as well as vocational impairment and interpersonal difficulties. This study examined the link between Continues Performance and everyday living skills. Methodes: Sample was 20 Schizophrenia (11 male and 9 female) selected using convenience sampling among individual with Schizophrenia diagnostic and 20 (10 male and 10 female) were matched with them as control group considering sex, age, marriage and education . Instruments were used in this study include: UCSD Performance-Based Skills Assessment Test (UPSA) and Continues Performance Test (CPT). Results: MANOVA showed a significant main effect for five domain of UPSA and four domain of UPSA. CPT predicted UPSA in schizophrenia. Conclusions: Individuals with schizophrenia would perform significantly worse in everyday living skills and on CPT. In fact poorer performance in CPT predicted basic skills performance in schizophrenia. This will help to determine what specifically needs to be targeted in rehabilitation of cognitive symptoms for those with schizophrenia, and that may reveal remediation in functional capacity as well. DOI: 10.5901/mjss.2015.v6n2s1p141

UCSD Performance-Based Skills Assessment (UPSA): validation of a Brazilian version in patients with schizophrenia

The UCSD Performance-based Skills Assessment (UPSA) is a measure of Functional Capacity and assesses skills involved in community tasks. It has good psychometrics properties, and is currently recommended as a co-primary assessment of cognition in the MATRICS Project. To our knowledge so far, there are no studies in western developing countries concerning Functional Capacity in Schizophrenia. The aims of this study were to translate, culturally adapt and validate the UPSA to assess Functional Capacity in community-dwelling patients with Schizophrenia living in Brazil. Eighty-two subjects (52 patients, 30 controls) were evaluated using: the Brazilian version of the UPSA (UPSA-1-BR), PANSS, Personal and Social Performance (PSP) and Global Assessment of Functioning (GAF). In the reliability test, UPSA-1-BR showed good Internal Consistency (Cronbach’s alpha of 0.88) and strong correlation between test and retest (4-month gap; r = 0.91; p < 0.01). Spearman’s rho values showed a moderate correlation between UPSA-1-BR and both PSP (0.50; p < 0.01) and GAF (0.46; p < 0.01) scores. UPSA-1-BR is capable of differentiating people with and without Schizophrenia. Patients scored lower than controls (58.9 versus 79.1), with an AUC of 0.79 (95%IC: 0.69–0.89). Sensitivity and specificity values of 0.71 and 0.70, respectively, were found in the cut-off point of 73.5, for separation of patients and controls, with predictive values of 80% (positive) and 58% (negative). UPSA-B-BR was also evaluated. UPSA-1-BR and its brief version presented adequate psychometric properties and proved to be valid and reliable instruments in the assessment of Functional Capacity in subjects with Schizophrenia.

Accurate perception of negative emotions predicts functional capacity in schizophrenia

Several studies suggest facial affect perception (FAP) deficits in schizophrenia are linked to poorer social functioning. However, whether reduced functioning is associated with inaccurate perception of specific emotional valence or a global FAP impairment remains unclear. The present study examined whether impairment in the perception of specific emotional valences (positive, negative) and neutrality were uniquely associated with social functioning, using a multimodal social functioning battery. A sample of 59 individuals with schizophrenia and 41 controls completed a computerized FAP task, and measures of functional capacity, social competence, and social attainment. Participants also underwent neuropsychological testing and symptom assessment. Regression analyses revealed that only accurately perceiving negative emotions explained significant variance (7.9%) in functional capacity after accounting for neurocognitive function and symptoms. Partial correlations indicated that accurately perceiving anger, in particular, was positively correlated with functional capacity. FAP for positive, negative, or neutral emotions were not related to social competence or social attainment. Our findings were consistent with prior literature suggesting negative emotions are related to functional capacity in schizophrenia. Furthermore, the observed relationship between perceiving anger and performance of everyday living skills is novel and warrants further exploration.

Neurocognition, functional capacity, and functional outcomes: The cost of inexperience

BackgroundNeurocognitive impairments are the strongest predictor of functional deficits in schizophrenia, but adaptive (i.e., functional) capacity, typically measured with performance-based assessments, yields an objective index of current abilities, whereas real-world functional performance relies on observations of community activity. However, limited experiences in the community may limit the acquisition, retention, or expression of these skills. MethodsWe examined the frequency of engagement in behaviors that are assessed in the current “gold standard” in person functional capacity assessment. The UCSD Performance-Based Skills Assessment (i.e., UPSA) examines skills associated with recreational engagement, handling money, scheduling appointments, and navigating public transportation. We used neurocognition, experience, and UPSA performance as predictors of the relationships among cognition and real-world functioning variables. ResultsNeurocognition was a significant correlate of UPSA scores regardless of whether it was forced into the model before or after prior experience, whereas experience was only a significant predictor of UPSA scores when entered before neurocognition. Further, functional capacity, neurocognition, and experience were significant predictors of real-world outcomes and experience remained a significant predictor regardless of the order it was entered into the model. ConclusionsThe amount of current experience with functional tasks is not a rate-limiter of the relationships between neurocognition and functional capacity but does account for some previously unexplained variance in the functional capacity–everyday functioning relationship. These findings underscore the importance of neurocognitive deficits as they relate to functional capacity in schizophrenia, and suggest an incremental functional cost of limited experience with independent living.

Factor Structure of Neurocognition and Functional Capacity in Schizophrenia: A Multidimensional Examination of Temporal Stability

Although neurocognition is commonly described in terms of different functional domains, some factor analytic studies have suggested a simpler dimensional structure for neuropsychological (NP) tests in patients with schizophrenia. Standardized tasks of everyday functioning, or tests of "functional capacity" (FC), are viewed differently from traditional NP tests, and are hence used as a co-primary measure in treatment studies. However, FC and NP tests have been found to be highly correlated. In fact, a recent study of ours suggested that performances on these different types of tasks constituted a single latent trait in a cross-sectional analysis. The current study examined the longitudinal factor structure of a combined set of NP and FC tests. Patients with schizophrenia (n = 195) were examined at two assessment occasions separated by periods ranging from 6 weeks to 6 months. Participants were assessed with the MATRICS Consensus Cognitive Battery (MCCB) and two performance-based assessments of FC. A single latent trait was extracted using full information maximum likelihood procedures, and its temporal stability was examined in terms of: stability of the latent trait scores, the inter-correlations of the three indicators of the latent trait, and the stability of loadings for the FC and NP items underlying the latent trait at the two measurement occasions. All indices of temporal stability were confirmed, with stability not related to follow-up duration. Variation in clinical symptoms and treatments across the measurement occasions was negligible. These findings raise the question of whether cognitive abilities measured by NP tests and FC instruments are tapping a single ability construct, which might have shared causal influences as well.

Effect of the neuroprotective peptide davunetide (AL-108) on cognition and functional capacity in schizophrenia

BackgroundCognitive dysfunction is a key predictor of functional disability in schizophrenia. Davunetide (AL-108, NAP) is an intranasally administered peptide currently being developed for treatment of Alzheimer's disease and related disorders. This study investigates effects of davunetide on cognition in schizophrenia. MethodSixty-three subjects with schizophrenia received davunetide at one of two different doses (5, 30mg) or placebo for 12weeks in a multicenter, double-blind, parallel-group randomized clinical trial. The MATRICS Consensus Cognitive Battery (MCCB) assessed cognitive effects. The UCSD Performance-based Skills Assessment (UPSA) and the Schizophrenia Cognition Rating Scale (SCoRS) assessed functional capacity. Subjects continued their current antipsychotic treatment during the trial. ResultsThere were no significant differences in MCCB change between davunetide and placebo over the three treatment arms (p=.45). Estimated effect-size (d) values were .34 and .21 favoring the 5 and 30mg doses vs. placebo, respectively. For UPSA, there was a significant main effect of treatment across study arms (p=.048). Between-group effect size (d) values were.74 and .48, favoring the 5 and 30mg doses, respectively. No significant effects were observed on the SCoRS or on symptom ratings. No significant side effects or adverse events were observed. ConclusionDavunetide was well tolerated. Effects of davunetide on MCCB-rated cognition were not significant relative to placebo. In contrast, a significant beneficial effect was detected for the UPSA. Based upon effect-size considerations, sample sizes of at least 45–50 subjects/group would be required to obtain significant effects on both MCCB and UPSA, providing guidance for continued clinical development in schizophrenia.

The association between verbal memory, processing speed, negative symptoms and functional capacity in schizophrenia

The aim of this paper is to explore the links among verbal memory, processing speed, negative symptoms, and functional capacity, using structural equation modeling techniques. Model A is a multiple regression model with cognitive and symptom variables as predictors and functional capacity as the latent outcome variable. Model B consists of three two mediator models that assess the ability of each variable to mediate the effect of the other variable on outcome conditional on the inclusion of the other mediator in the model. Ninety-eight community-dwelling patients with schizophrenia (mean age=35.8years, S.D.=10.1) participated in the study. Results indicate that verbal memory, processing speed and negative symptoms significantly contributed to functional status. Verbal memory was at least partially mediated by processing speed in its effect on outcome, while the impact of processing speed on outcome was mediated by both verbal memory and negative symptoms. The influence of negative symptoms on functional capacity was partially mediated by processing speed. These findings enrich our understanding of the direct and indirect effects of these three interrelated variables and provide a basis for the development of intervention strategies.

LANGUAGE, ACCULTURATION, AND FUNCTIONAL CAPACITY ASSESSMENT IN SCHIZOPHRENIA

The effects of language and acculturation on measurement of functional capacity in schizophrenia are not yet fully understood. We assessed functional capacity using the UCSD Performance-Based Skills Assessment (UPSA), Social Skills Performance Assessment (SSPA), and Medication Management Ability Assessment (MMAA) in Englishspeaking (n=210) and monolingual Spanish-speaking (n=29) individuals with schizophrenia-spectrum disorders. The two groups did not differ on age, severity of positive, negative, and depressive symptoms, of Global Assessment of Functioning scores. However, the Spanish-speaking sample had less education, later age of onset of psychosis, lower Dementia Rating Scale scores, and lower dosages of antipsychotics; they were also more likely to be female, to have schizoaffective disorder (vs. schizophrenia), and to be married. The Spanish-speaking group performed better than did English speakers on theMMAA, butworse on the UPSA. The groups did not differ on the SSPA. In a multiple hierarchical regression controlling for group differences, DRS score (p<.001) and language (p=.008) predicted UPSA performance (R=.74). Within the Spanish-speaking sample, higher levels of education and acculturationwere both associatedwith better UPSA performance (rs=.61, .78, ps<.001), but did not explain variance in UPSA performance beyond that accounted for by DRS performance. These results suggest that measurement of functional skills can be strongly affected by language of test administration. Although acculturation is associated with functional capacity among monolingual Spanish-speakers with schizophrenia, it does not predict performance once cognitive performance is considered.