Schizophrenia Patient Outcomes Research Articles

Detecting specific patterns of change in patients with schizophrenia: a latent class analysis

Background/Objectives: Describing and predicting the developmental course of disease in patients with severe mental illness is a central theme in psychiatric inquiries. Latent growth modelling approaches, such as latent class growth analysis, have been increasingly recognised for their usefulness in identifying homogeneous subpopulations within the larger heterogeneous population as well as meaningful groups or classes of individuals. This study focuses on latent class analysis as a means to represent the various courses of disease in patients with schizophrenia and schizoaffective disorders. We examine two research questions: (1) Is it possible to identify latent subgroups of patients characterized by different shapes of trajectories?, and (2) Is it possible to predict the class membership by patients’ sociodemographic and clinical characteristics? Methods: In a prospective longitudinal study with 5 points of measurement over a period of two years, the course of disease of 374 adults living in Southern Germany with a diagnosis of schizophrenia or schizoaffective disorders was assessed. Interviews were conducted face-to-face by clinical psychologists trained in using the study instruments for assessing study participants’ psychopathology (Positive and Negative Syndrome Scale), global functioning (Global Assessment of Functioning Scale), quality of life (Berliner Life Quality Profile), and cognitive functionality (Digital Symbol Coding Subtest from the Wechsler Adult Intelligence Scale). Latent Class mixture models were used to identify patterns of change. These models aim to uncover unobserved heterogeneity in a population and to find substantively meaningful groups of people that are (almost) equal in their responses to measured variables or growth trajectories. Results: The latent growth modelling of change patterns resulted in three types of clinically relevant and significant classes of change processes. Those patterns were related to specific patient variables at study entrance and were also associated with differenzial indicators of life circumstances. In addition, the results confirmed the mediating role of cognition; cognitive deficits are a core feature of schizophrenia and the results suggested that they can significantly predict clinical and social outcome in schizophrenia patients. Discussion/Conclusions: The findings suggest utility in using the latent class analysis in order to better understand predictors of course of disease. Results may inform the development of more effective prevention and intervention efforts targeting patients on different disease trajectories. Thus, the modelling of change patterns in people with schizophrenia can be helpful in identifying negative and positive treatment developments. Further applications of these methods as well as clinical relevance are discussed. Funding: The ELAN study was funded as an investigator-initiated research project by a grant from AstraZeneca Deutschland to the University of Tubingen (grant no. 229/2004V). Keywords: Patient outcome assessment, course of disease, longitudinal study.

P03-277 - The EMEA ADHES survey in schizophrenia: psychiatrists’ perceptions of the extent of assessment and management of partial and non-adherence to medication

IntroductionPartial or non-adherence to medication is high amongst patients with schizophrenia. Rates of non-adherence of up to 72% have being reported depending on the method used and the patient population. Adherence is essential for optimal long-term patient outcomes in schizophrenia and failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.ObjectivesThe objective of the EMEA (Europe, Middle east and Africa) ADHES survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.AimsThe aim of this poster is to present psychiatrist's perceptions collected in the EMEA ADHES survey.MethodsThe survey was devised to ascertain psychiatrists’ preferred methods of assessing adherence, their perceptions of the level of adherence, reasons for non-adherence and on strategies to improve adherence.ResultsPsychiatrists estimated that during the previous month more than half of their patients (53%) were partially or non-adherent. They estimated that as few as a third of patients who deteriorated after stopping medication was able to attribute this to their non-adherence. 76% of psychiatrists assessed adherence most frequently by asking their patient explicitly. Use of long-acting treatment was the preferred choice to address adherence problems for 62% of respondents.DiscussionThis EMEA-wide survey illustrates that while respondents recognised the relevance and importance of partial and non-adherence to medication, there remains a need for more proactive management of treatment adherence of patients with schizophrenia to reduce the frequency and consequences of relapse.

Measuring psychosocial outcomes in schizophrenia patients

Improvement in psychosocial functioning is nowadays considered an important and achievable goal of schizophrenia treatment. Therefore, treatment interventions are expected to have a positive influence both on symptoms and on social integration.In this nonsystematic literature review, we describe some of the available measures to assess social outcomes in schizophrenia treatment and their inherent limitations, and discuss future directions for research and clinical practice. The lack of consensus on the appropriate terminology and standards applied to index patients' level of functioning remains an obstacle in assessing psychosocial outcomes in schizophrenia. Although some scales appear advantageous in terms of ease of administration and reliability, they lack enough solid evidence that they are related to real-world outcomes or sensitive to change. Performance-based measures are being more widely used to assess functional capacity because they appear effective in predicting independent living and work, as compared with both self-report and clinical measures. We argue that assessment of psychosocial functioning should be an integral part of schizophrenia patients' assessment, in both the research and clinical setting. Ultimately, there exists no gold standard measure, but, of those available, the Personal and Social Performance (PSP) Scale and the UCSD Performance-based Skills Assessment (UPSA) have literature supporting their usefulness for assessing psychosocial outcomes in schizophrenia patients.

Mismatch Negativity, Social Cognition, and Functioning in Schizophrenia Patients

Cognition and social cognition have been found to influence functional outcome in schizophrenia patients. However, little is known about the underlying neural substrates that are associated with social cognition or daily functioning. Prior studies found associations between mismatch negativity (MMN), an event-related potential response indexing early auditory processing, and functioning in schizophrenia patients. In this study, we examined MMN, social cognition (social perception and theory of mind), and four domains of functioning (work, independent living, social networks, and family networks) in 33 schizophrenia patients and 42 demographically comparable healthy control subjects. Schizophrenia patients exhibited reduced MMN activity at frontocentral electrode sites compared with healthy control subjects. Within the schizophrenia sample, greater MMN activity at frontocentral sites correlated with better work and independent living (but not social or family networks) and with better social perception. These results suggest that MMN activity is more closely tied to some outcome domains (work and independent living) than others. Mismatch negativity has been previously shown to be associated with basic cognition and functional outcome in schizophrenia, but these findings are the first, to our knowledge, to show MMN associations with social cognition. These results are consistent with cascade models of information processing in which deficits in early perceptual processing have a downstream impact on higher order social cognition and community functioning.

Treatment retention with risperidone long-acting injection: 24-month results from the Electronic Schizophrenia Treatment Adherence Registry (e-STAR) in six countries

Objective:To assess treatment retention on risperidone long-acting injection (RLAI) and outcomes in schizophrenia patients for whom 24 months of follow-up data in the electronic Schizophrenia Treatment Adherence Registry (e-STAR) were available.Research design and methods:e-STAR is an ongoing, international, multicenter, prospective, observational registry assessing use of antipsychotics in patients with schizophrenia or schizoaffective disorder in a normal clinical practice setting. Parameters were assessed prior to and post-initiation of RLAI. Data presented are from six European countries that enrolled patients in e-STAR after they initiated treatment with RLAI.Main outcome measures:Clinical and demographic information were collected at baseline and treatment-related data, including RLAI discontinuation, psychiatric hospitalization and medication utilization, were collected prospectively every 3 months. Data collection continued for 24 months, even for patients who discontinued RLAI therapy. Hospitalization and medication utilization were also collected retrospectively by chart review for the 12-month period prior to RLAI initiation.Results:A total of 1659 patients (mean age, 39.2; 18.3% inpatients) completed the study. Twenty-four months after initiating therapy (initial RLAI dose = 33.6 mg) 85% of patients (n = 1410) remained on RLAI (completers) while 15% discontinued therapy. The main reasons for discontinuation were insufficient response (28.5%), patient/family choice (26.1%), adverse events (9.6%) and unacceptable tolerability (6.0%). At baseline, compared to completers, discontinuers were younger (37.4 vs. 39.6 years, p = 0.01), had schizophrenia for a shorter time (10.2 vs. 11.9 years, p = 0.02), had lower Global Assessment of Functioning (GAF) scores (43.5 vs. 48.0, p = 0.0001), higher utilization of benzodiazepines (56.5 vs. 43.3%) and more initiated therapy as inpatients (30 vs. 16%). With RLAI therapy GAF scores improved significantly (p < 0.001) for both groups but the 24-month value for discontinuers was lower than that of completers (55.4 vs. 67.2). Compared to the pre-RLAI initiation period, at 12 months post-initiation completers had greater reductions than discontinuers in the percent of patients hospitalized (66.2% reduction vs. 29.2%) and in the length (68% reduction vs. 0%) and number (80.0 vs. 14.3%) of hospital stays, differences that remained at 24 months. The most common adverse events while patients were taking RLAI were nervous system disorders (6.8%), psychiatric disorders (5.6%), weight increase (3.2%), reproductive system and breast disorders (2.5%) and gastrointestinal disorders (2.1%).Conclusions:These observational data confirm that RLAI is an effective treatment in schizophrenia and high levels of adherence to therapy offers an opportunity for effective long-term disease management and significant sustained decreases in hospitalization.

Inflammatory Markers in Schizophrenia: Comparing Antipsychotic Effects in Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness Study

C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin are systemic inflammatory markers (IM) that positively correlate with cardiovascular (CV) risk. Despite the known CV effects of atypical antipsychotics, there is limited prospective data on IM changes during treatment. The IM outcomes were compared between antipsychotic treatment groups in the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) schizophrenia trial phase 1 with subjects with laboratory assessments at baseline and 3 months (n = 789). There were significant treatment differences in CRP, E-selectin, and ICAM-1 at 3 months, with a differential impact of baseline values on the CRP and ICAM-1 results. In overall comparisons, quetiapine and olanzapine had the highest median levels for CRP, and olanzapine for E-selectin and ICAM-1. Olanzapine was significantly different after baseline adjustment than perphenazine (p = .001) for E-selectin, and in those with low baseline CRP (<1 mg/L), olanzapine was significantly different than perphenazine (p < .001), risperidone (p < .001), and ziprasidone (p = .002) for CRP. Perphenazine had the lowest 3-month ICAM-1 levels in subjects with baseline ICAM-1 above the median, but the differences were not statistically significant versus olanzapine (p = .010), quetiapine (p = .010), and risperidone (p = .006) after controlling for multiple comparisons. The 18-month repeated measures CRP analysis confirmed the significantly higher values for olanzapine in those with low baseline CRP. This analysis provides further evidence for differential antipsychotic metabolic liabilities as measured by changes in systemic inflammation. C-reactive protein might emerge as a useful target for CV risk outcomes in schizophrenia patients.

Outcomes for schizophrenia patients with clozapine treatment: how good does it get?

The objective of this study was to describe the extent/change (2000-2004) of clozapine prescribing in schizophrenia in New Zealand and examine the outcomes associated with increasing treatment duration, and vs. those who discontinue clozapine. Consecutive chart reviews were conducted for adult outpatients in Auckland/Northland regions (T1 = 31 March 2000, T2 = 31 October 2001, T3 = 31 March 2003, T4 = 31 October 2004). Data collected included: patient characteristics, social/functional indicators, diagnosis, duration of illness, psychiatric admissions and treatment information (psychotropic medication, dose, route of administration). Between 2000 and 2004, clozapine for schizophrenia increased from 21.0% to 32.8%. Of those prescribed clozapine at T1, 86.1% were engaged with community services at T4 and 93.2% still prescribed clozapine. Continuing clozapine treatment (vs. other treatment) led to a trend to higher rates of regular occupational activity (37% vs. 14.3%) and lower rates of compulsory treatment (25.1% vs. 46.4%) and significantly lower hospitalisation rates (mean = 0.6 vs. mean = 3.1). For those prescribed clozapine at T4, increasing treatment duration (< or = 10 months, 2-3 years, >3 years) led to a trend to higher rates of living independently (18% vs. 29.2% vs. 34%) and regular occupational activity (26.2% vs. 32.6% vs. 37.5%), and significantly reduced compulsory treatment (44.3% vs. 36.9% vs. 28.6%) and hospitalisation rates in the previous 18 months (1.5 vs. 0.5 vs. 0.2). Clozapine use increased significantly over 4.5 years to expected rates of treatment-resistant schizophrenia. Low clozapine discontinuation rates were found and continuing treatment was associated with real-world improvements in functional and clinical outcomes. These findings support the recommendation of prolonged clozapine trials to improve cost-effectiveness in the most seriously unwell schizophrenia patients.

Australian Schizophrenia Care and Assessment Programme: Real-World Schizophrenia: Outcomes

It has been increasingly recognized that there is need to assess patient outcomes in schizophrenia across a broad range of dimensions. But few studies have attempted to do this in clinical populations and no systematic study has broadly assessed outcomes in schizophrenia in Australia using a longitudinal design. Thus, a real-world study, the Schizophrenia Care and Assessment Programme (SCAP), was structured to collect comprehensive information over time to inform policy debate and extend current knowledge about the course of schizophrenia in an Australian context. A cohort of 347 patients with schizophrenia was followed up over 3 years. Clinical outcomes, occupational and psychosocial functioning and quality of life were assessed at 6 monthly intervals, and resource utilization and costing data were collected continuously from internal and external databases as well as from participants directly. The participants as a group experienced an overall decline in positive and negative symptoms of schizophrenia, a reduction in general psychopathology and a reduction in severity of depression. There was an improvement in functioning, a reduction in mental health-related disability and an improvement in patient- and observer-rated quality of life. Change of severity within the variously assessed domains over time appeared to be relatively independent. In the present sample of schizophrenia patients treatment was associated with positive health outcomes; but outcomes across assessment domains did not closely correlate across time. The scrutiny of a broad range of patient outcomes will assist with the assessment of new treatment modalities and with service planning.

Dr. Keefe and Colleagues Reply

Dr. Keefe and Colleagues Reply

Effectiveness of atypical antipsychotics for substance use in schizophrenia patients

ObjectiveThis study examined the influence of medication class (atypical antipsychotic, typical antipsychotic and no medication) and compliance on substance use outcomes for schizophrenia patients in the community. MethodN=362 adults with schizophrenia-spectrum disorder were followed for 3 years in a naturalistic study with structured interviews at 6-month intervals. Multivariable time-series analysis was performed using propensity-score adjustment for selection to medication class. ResultsParticipants who were compliant with atypical antipsychotic medications for 90 days or more during each 6-month period were significantly less likely to use substances during the next 6-month period than patients who were compliant with typical antipsychotics or those who were not prescribed either type of medication for at least 90 days. ConclusionAtypical antipsychotics may offer an advantage in reducing substance use among schizophrenia patients. For patients to benefit from atypical antipsychotics, treatment should focus on enhancing compliance and integrating substance use treatment.

Who Receives Long-Acting Antipsychotic Medications?

Back to table of contents Next article Taking IssueFull AccessWho Receives Long-Acting Antipsychotic Medications?William M. Glazer M.D.,William M. Glazer M.D.Search for more papers by this author,Published Online:1 Apr 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In my psychiatric rotation in medical school in 1972, I quickly learned that depot fluphenazine was used for "noncompliant" patients. In 1978, I found, to my consternation, that my mental health center prescribed this medication significantly more often to African-American patients than to Caucasians. Similar prescribing practices were found in other settings. In 2006 psychiatrists have two other long-acting injectable medications to choose from, and we consider the term "noncompliant" to be pejorative and prefer "nonadherent." But we still believe that these agents are for nonadherent patients. We have not made much progress over the past 30 years.In this issue Shi and colleagues report on a large three-year, prospective observational study of patients treated for schizophrenia. Although the study, funded by Eli Lilly and Company (for which I am a consultant and speaker), was not designed to identify why clinicians choose depot antipsychotics, it is the most comprehensive one to characterize the patients receiving these medications. The authors report that patients treated with a first-generation depot medication were more likely than those receiving oral medications to be younger, male, African American, less educated, and more clinically and socially dysfunctional. Over the one-year follow-up period adherence improved while these patients received depot medications.The study would suggest that nonadherence is not the only indication for depot antipsychotics. However, if nonadherence is a reasonable indication for these medications, then we are not coming close to meeting that need. The low point prevalence of use of these agents in the United States (10%–15%) hardly matches the estimated rate of nonadherence (<50%) in the population treated. So what, exactly, is the indication for depot antipsychotics?Little evidence supports the characteristics noted in the study as predictors of nonadherent behavior. And common sense tells us that this small subgroup of patients is not the only one to benefit from long-acting antipsychotics. So what has happened? For reasons that are too complex to discuss here, we seem to relegate the use of depot medications to uninsured, substance-abusing patients who belong to racial and ethnic minority groups or have criminal histories.Shi and colleagues' findings indicate a need for a deeper understanding of our prescribing behavior with depot antipsychotics. We seem to prescribe these medications with erroneous assumptions that reveal some prejudices—such as prescribing them on the basis of race or predicted dangerousness rather than problematic adherence. We must explore why U.S. clinicians, compared with many non-U.S. clinicians, resist using long-acting antipsychotics. We need to look at cultural forces that may drive what, I fear, is a punitive attitude in our prescription of depot medications.President, Glazer Medical Solutions FiguresReferencesCited byDetailsCited ByAchieving better outcomes for schizophrenia patients in Hong Kong: Strategies for improving treatment adherence8 February 2021 | CNS Neuroscience & Therapeutics, Vol. 27, No. S1Impact on length of stay and readmission rates when converting oral to long-acting injectable antipsychotics in schizophrenia or schizoaffective disorderMental Health Clinician, Vol. 6, No. 5SSRN Electronic JournalThe role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal2 July 2014 | Therapeutic Advances in Psychopharmacology, Vol. 4, No. 5The Effect of Race-Ethnicity and Geography on Adoption of Innovations in the Treatment of SchizophreniaMarcela Horvitz-Lennon, M.D., M.P.H., Margarita Alegría, Ph.D., and Sharon-Lise T. Normand, Ph.D.1 December 2012 | Psychiatric Services, Vol. 63, No. 12Journal of Medical Economics, Vol. 15, No. 4BMC Psychiatry, Vol. 9, No. 1Current Psychiatry Reports, Vol. 10, No. 4 Volume 58Issue 4 April, 2007Pages 437-437PSYCHIATRIC SERVICES April 2007 Volume 58 Number 4 Metrics PDF download History Published online 1 April 2007 Published in print 1 April 2007

Improving patient outcomes in schizophrenia: achieving remission

The Remission in Schizophrenia Working Group has recently proposed a consensus definition of remission in schizophrenia and, based on this definition, has developed specific operational criteria for the assessment of remission. The aim of this article was to assess the application of these consensus criteria and to discuss the barriers for achieving remission. An electronic literature search of studies published between January 1990 and December 2005 examining the concepts of remission, compliance and patient satisfaction in schizophrenia was performed using Medline and EMBASE. The primary research parameters were 'schizophrenia', 'remission', 'antipsychotics', 'atypicals' and 'conventional'. Abstracts and posters presented at key psychiatry congresses during this period were also reviewed, where available in the public domain. To date, the remission criteria have been applied retrospectively to a number of clinical studies, and these have demonstrated that the proposed definition of remission correlates significantly with established measures of symptom severity, functioning and quality of life, and appears achievable and sustainable for a significant proportion of patients receiving pharmacotherapy. The atypical antipsychotic agents have been shown to impact favourably upon certain factors that play an integral part in the achievement of remission, such as negative symptoms, cognitive impairment, social functioning and quality of life. However, non-compliance with medication remains widespread due to illness-, treatment- and clinician-related factors. The use of long-acting antipsychotic agents, with their assured medication delivery, may facilitate compliance and improve long-term treatment outcomes, possibly assisting patients in achieving remission. Remission may, therefore, be considered as a current goal of treatment today, not a distant future aim.

White matter fractional anisotropy and outcome in schizophrenia

Objective Disparate white matter fractional anisotropy (FA) findings have been reported in patients with schizophrenia in recent years. This may in part reflect heterogeneity of subjects in the studies, including differences in outcome and severity of the illness. We examined whether there is a relationship between white matter FA and outcome in patients with schizophrenia. Method Diffusion-tensor images were obtained in 41 normal subjects and 104 patients with schizophrenia, divided into good-outcome ( n = 51) and poor-outcome (Kraepelinian; n = 53) subtypes based on their ability for self-care. White matter FA and its relationship to regional tissue volumes were evaluated across 40 individual Brodmann's areas using a semi-automated parcellation technique. Results Overall white matter FA was lower in schizophrenia patients than normal subjects, with regional reductions in widespread temporoparietal and selected prefrontal white matter regions. In schizophrenia patients, lower regional white matter FA was associated with lower regional gray matter volumes. In comparison to normal subjects, overall white matter FA was reduced in patients with poor outcomes in both hemispheres, but to a lesser extent and only in the right hemisphere in good-outcome patients. Lower regional FA was associated with larger regional white matter volumes in good-outcome group. Conclusions Global FA reductions implicate white matter as tissue type in the pathophysiology of schizophrenia. In contrast to poor outcome, good outcome in schizophrenia patients may be associated with less extensive FA reductions, higher FA in regional frontal and cingulate white matter, and correlated increases in regional white matter volumes, particularly in the left hemisphere.

Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects

Objective. – The present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care. Method. – Sixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated. Results. – Most psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care. Conclusion. – Our results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.

Patient outcomes in schizophrenia II: the impact of cognition

Background. – Cognitive dysfunction is increasingly considered to be the strongest clinical predictor of poor long-term outcome in schizophrenia. Associations have been found between the severity of cognitive deficits and social dysfunction, impairments in independent living, occupational limitations, and disturbances in quality of life (QOL). Methods. – In this cross-sectional study, the relationships of cognitive deficits and treatment outcomes in terms of QOL, needs, and psychosocial functioning were examined in 60 outpatients with schizophrenia who had a duration of illness over 2 years and had been treated with either clozapine or olanzapine for at least 6 months. Results. – The present study suggests that cognitive functioning might be a predictor of work functioning/independent living outcome in stabilized patients with schizophrenia: deficits of visual memory and working memory were negatively associated with occupational functioning, and older patients lived independently and/or in a stable partnership more often. The patients' assessments of QOL and needs for care did not show any significant associations with cognitive functioning. Discussion. – These findings suggest that cognitive functioning is a key determinant of work functioning/independent living for stable outpatients with schizophrenia.

An investigation of models of illness in carers of schizophrenia patients using the Illness Perception Questionnaire.

Although carers' reactions to schizophrenic illness in a close family member may have important implications for the patient and for themselves, little is known of factors that influence the way carers respond. In the area of physical health problems, people's models of their illness or illness representations have been found to be related to the ways they react and cope with their illness. This study examines the use of a modified form of the Illness Perception Questionnaire (IPQ) to investigate illness models in a sample of carers of schizophrenia patients. Forty-seven carers participated. The psychometric properties of the modified IPQ were examined, and a number of carer and patient outcomes were investigated in relation to carer scores on the illness identity, consequences, control-cure and timeline subscales of the modified IPQ. These outcomes included measures of carer distress and burden, expressed emotion dimensions, and patient functioning. The modified IPQ was found to be a reliable measure of carers' perceptions of schizophrenia. Carer functioning, the patient-carer relationship and patient illness characteristics were associated with different dimensions of illness perceptions. The findings support the proposal that carer cognitive representations of the illness may have important implications for both carer and patient outcomes in schizophrenia.

Executive function in schizophrenia.

Many domains of executive function are impaired in patients with schizophrenia including forward planning, concept formation, initiation, self-monitoring, and the ability to direct attention and memory. These impairments are noticeable against a background of generalized cognitive deficits, and many affect 40% to 95% of individuals with this disorder. Specific executive deficits appear to be related to specific symptom clusters and are linked to structural and functional brain abnormalities. Executive impairment predicts multiple domains of functional outcome in schizophrenia patients. Atypical antipsychotic agents and cognitive rehabilitation may be promising new approaches for the treatment of cognitive and functional impairment in schizophrenia.