Social Functioning Scale Scores Research Articles

Digital phenotyping of social functioning and employment in people with schizophrenia: Pilot data from an international sample.

Individuals living with schizophrenia experience significant impairments in social functioning. As a major clinical outcome, social functioning requires appropriate measurement tools that can capture its dynamic nature. Digital phenotyping, using smartphone technology to collect high volume ecologically valid data, can potentially capture these facets. We investigated the viability of digital data, such as GPS, Accelerometer, and screen activation as a proxy for common social functioning measurements. We used an ordinary least squares linear regression approach to compare the performance of digital signals with the performance of past social functioning scale (SFS) scores for predicting current SFS scores and subdomain values in 62 individuals with schizophrenia using smartphone and clinical assessments over the course of a year. The outcome of interest was the current SFS, for which we compared the capacity of the digital data (active and passive), and prior SFS scores to predict SFS scores. Overall, the sub-scale models in order of performance (measured by RMSE score) were: (i) employment, (ii) social engagement, (iii) interpersonal behavior, (iv) recreation, (v) prosocial activities, (vii) performance, and (vii) competence. Digital data were particularly capable of predicting subdomain scores for employment (R2 = 0.746, Mean Squared Error (MSE) = 1.663) and social engagement (R2 = 0.710, MSE = 2.318). Digital phenotyping may have the capacity to operate as a proxy for certain social functioning measures. Future research should expand on this pilot data by focusing on establishing the reliability and validity of digital phenotyping to measure social functioning, and exploring which subdomains of social functioning are best measured digitally.

The impact of childhood trauma exposure on social functioning in schizophrenia: the moderated mediation role of oxytocin and oxytocin receptor gene polymorphisms.

Childhood trauma has been linked to increased risk of schizophrenia and social dysfunction, and oxytocin and its receptor gene have been implicated in regulating social behavior. This study investigated the potential role of oxytocin and oxytocin receptor gene (OXTR) in mediating the effects of childhood trauma on social functioning in schizophrenia. The study consisted of 382 patients with schizophrenia and 178 healthy controls who were assessed using the Taiwanese version of the Childhood Trauma Questionnaire (CTQ-SF), the Social Functioning Scale (SFS), and plasma oxytocin levels. DNA was extracted to genotype the OXTR and ten single-nucleotide polymorphisms (SNPs; rs2254298, rs237885, rs237887, rs237899, rs53576, rs9840864, rs13316193, rs7632287, rs1042778, and rs237895) were selected. Patients with schizophrenia showed higher CTQ-SF scores (t = 12.549, p < 0.001), lower SFS scores (t = -46.951, p < 0.001), and lower plasma oxytocin levels (t = -5.448, p < 0.001) compared to healthy controls. The study also found significant differences in OXTR SNPs between both groups, with risk alleles being more prevalent in patients with schizophrenia (t = 2.734, p = 0.006). Results indicated a significant moderated mediation effect, with oxytocin and the OXTR SNPs partially mediating the relationship between childhood trauma exposure and social functioning in patients with schizophrenia (index of mediation = 0.038, 95% CI [0.033-0.044]). The findings suggest that oxytocin and its receptor gene may be promising targets for interventions aimed at improving social functioning in patients with a history of childhood trauma and schizophrenia. However, further research is needed to fully understand these effects and the potential of oxytocin-based interventions in this population.

Can reduced leftward asymmetry of white matter integrity be a marker of transition to psychosis in at-risk mental state?

As a biomarker for the degree of psychosis development, the lateral asymmetry of white matter (WM) integrity in each area of the cerebrum has been investigated; as a result, a reduced leftward asymmetry of WM integrity has been reported in patients with schizophrenia. Although individuals with an at-risk mental state for psychosis (ARMS) who subsequently develop psychosis are believed to have poorer social functioning, only a few studies have actually examined the associations between WM abnormalities and social functioning. The aim of the present study was to clarify the possibly predictive association between a reduced asymmetry of WM integrity and impairments in social functioning in patients with ARMS. Thirty ARMS subjects underwent MRI scanning and were assessed using the Social Functioning Scale (SFS). We examined the fractional anisotropy (FA) values in the cingulum bundle (CB) and the uncinate fasciculus (UF) using a tract-specific analysis. Lateral asymmetry was assessed using the laterality index (LI). The LI of the FA value was positive (leftward) in the CB and negative (rightward) in the UF. Although the LI was not correlated with the Scale of Prodromal Symptoms (SOPS) score, the LI in the CB was positively correlated with the SFS score. In ARMS patients, the degree of reduced leftward asymmetry in the CB might affect deteriorations in social functioning and may be useful as a biomarker for predicting future outcomes at an early stage of psychosis.

Meta-analysis of physical activity and effects of social function and quality of life on the physical activity in patients with schizophrenia.

Schizophrenia patients have increased mortality and morbidity, mainly due to premature cardiovascular disease resulting from decreased physical activity (PA). However, which PA intensity is impaired in the patients and how factors such as social function and quality of life (QoL) are related to decreased PA is unknown. To assess PA, social function and QoL, the International Physical Activity Questionnaire (IPAQ), Social Functioning Scale (SFS) and Schizophrenia Quality of Life Scale (SQLS), respectively, were used in 109 schizophrenia patients and 69 healthy subjects. A meta-analysis comparing PA intensities (vigorous, moderate and light) assessed by the single PA measurement between schizophrenia patients and healthy subjects after including our case-control sample was performed. Furthermore, the effects of social function and QoL on each level of PA intensity were investigated in patients and controls. The meta-analysis in 212 schizophrenia patients and 132 healthy subjects revealed that patients showed lower total PA, particularly vigorous PA, than controls (I2 = 0, Hedges' g = - 0.41, P = 2.80 × 10-4). The decreased total PA was correlated with impaired total SFS scores (β = 0.24, P = 2.86 × 10-3), withdrawal (β = 0.23, P = 3.74 × 10-3) and recreation (β = 0.23, P = 3.49 × 10-3) without significant heterogeneity between patients and controls. In contrast, the decreased total PA was affected by low independence-performance (β = 0.22, P = 0.034), employment/occupation (β = 0.27, P = 8.74 × 10-3), psychosocial (β = - 0.24, P = 0.021) and motivation/energy (β = - 0.26, P = 0.013), but only in patients. Similar findings were obtained for vigorous PA but not moderate or light PA. Our findings suggest that the impaired vigorous PA in schizophrenia patients may be mediated by schizophrenia-specific factors of social functioning and QoL. Understanding these factors has important implications for increasing PA participation in schizophrenia patients.

Cognitive function, treatment response to lithium, and social functioning in Japanese patients with bipolar disorder.

Patients with bipolar disorder often suffer from cognitive impairment that significantly influences their functional outcome. However, it remains unknown whether lithium has a central role in cognition and functional outcome. We examined whether cognition and functional outcome were predicted by demographic and clinical variables, including the response to lithium, in lithium-treated patients with bipolar disorder. We evaluated 96 lithium-treated euthymic patients with bipolar disorder and 196 age- and-gender-matched healthy controls, using the Brief Assessment of Cognition in Schizophrenia (BACS). The patients were also assessed using the Social Functioning Scale (SFS) and "The Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" (Alda) scale, which was evaluated as either a continuous measure of the total scale or a dichotomous criterion. Multiple regression analysis revealed two key findings: first, that the premorbid intelligence quotient, age, and number of mood episodes were predictors of the BACS composite score; and, second, that the BACS composite score, negative symptoms, and continuous measure on the total Alda scale (but not its dichotomy) predicted the total SFS score. Structural equation modeling (SEM) was used to confirm these findings, and additionally revealed that the Alda scale was significantly associated with negative symptoms and also the number of mood episodes, regardless of how it was evaluated. SEM delineated how demographic and clinical variables, cognitive performance, and response to lithium treatment were causally associated with, and converged on, social function. The putative role of the Alda scale for social function warrants further study.

Omega-3 fatty acids related to cognitive impairment in patients with schizophrenia

Cognitive impairment is strongly associated with functional outcome in patients with schizophrenia but its pathophysiology remains largely unclear. Involvement of omega-3 fatty acids in the cognitive function of healthy individuals and patients with neuropsychiatric disease has received increasing attention. The aim of this study was to examine the relationship between omega-3 fatty acids with cognitive function, social function, and psychiatric symptoms in patients with schizophrenia. The subjects included 30 patients with schizophrenia or schizoaffective disorder. Psychiatric symptoms, cognitive function, and social function were assessed using the Positive and Negative Syndrome Scale, the Brief Assessment of Cognition in Schizophrenia (BACS), and the Social Functioning Scale (SFS), respectively. Blood serum omega-3 fatty acids were assessed using gas chromatography. The BACS composite score was significantly correlated with blood eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. In addition, a daily dose of antipsychotic medication was negatively and significantly correlated with the blood DHA level and with the BACS composite score. Step-wise multiple regression analyses demonstrated that the SFS score was significantly associated with the BACS composite score. Our results indicate that reduced blood omega-3 fatty acids are associated with cognitive impairment, which then impacts social functioning outcomes in schizophrenia.

Differences in social functioning among patients with major psychiatric disorders: Interpersonal communication is impaired in patients with schizophrenia and correlates with an increase in schizotypal traits

Impaired social functioning is a hallmark of major psychiatric disorders. The purpose of this study was to detect a disorder-specific factor of social dysfunction among patients with major psychiatric disorders (PSY), including schizophrenia (SCZ), bipolar disorder (BIP) and major depressive disorder (MDD). Social functioning was assessed in patients with SCZ (n=80), BIP (n=27) or MDD (n=29) and healthy controls (HC, n=68) using the Social Functioning Scale (SFS). Compared to HC, the SCZ, BIP and MDD patient groups showed lower total SFS scores. No differences in the total scores for social functioning were observed between patient groups. We next investigated seven subscales of the SFS among PSY and observed significant diagnostic effects on all subscales of the SFS. Notably, patients with SCZ have poorer interpersonal communication than patients with MDD. Furthermore, the poorer interpersonal communication score was significantly correlated with an increase in schizotypal personality traits, as assessed by the Schizotypal Personality Questionnaire (SPQ) in HC. Although there were no differences in overall social functioning among PSY, disorder-specific factors, such as interpersonal communication, were evident in SCZ. The correlation between poor interpersonal communication and the increase in schizotypal traits suggests that poor interpersonal communication may be an intermediate phenotype of SCZ.

Predicting employment status and subjective quality of life in patients with schizophrenia

Although impaired social functioning, particularly poor employment status, is a cardinal feature of patients with schizophrenia and leads to decreased quality of life (QOL), few studies have addressed the relationship between these two clinical issues. The aim of this study was to determine whether employment status predicts subjective QOL and to evaluate a model in which functional capacity mediates the relationship between general cognitive performance and employment status. Ninety-three patients with schizophrenia were administered a comprehensive battery of cognitive tests, the UCSD Performance-based Skills Assessment-Brief version (UPSA-B), the Social Functioning Scale (SFS), and the Subjective Quality of Life Scale (SQLS). First, we evaluated a model for predicting the employment/occupation subscale score of the SFS using path analysis, and the model fitted well (χ2 (4)=3.6, p=0.46; CFI=1.0; RMSEA<0.001, with 90% CIs: 0–0.152). Employment status was predicted by negative symptoms and functional capacity, which was in turn predicted by general cognitive performance. Second, we added subjective QOL to this model. In a final path model, QOL was predicted by negative symptoms and employment status. This model also satisfied good fit criteria (χ2 (7)=10.3, p=0.17; CFI=0.987; RMSEA=0.072, with 90% CIs: 0–0.159). The UPSA-B and SFS scores were moderately correlated with most measures of cognitive performance. These results support the notion that better employment status enhances subjective QOL in patients with schizophrenia.

Social Functioning and Internalized Stigma in Individuals Diagnosed with Substance Use Disorder

The aim of this descriptive study was to determine social functioning and internalized stigma in individuals with substance use disorder. The study sample consisted of 105 patients diagnosed with substance use disorder according to the DSM-IV-TR diagnostic criteria. A Descriptive Information Form, Internalized Stigma of Mental Illness Scale (ISMI) and Social Functioning Scale (SFS) were used for data collection. Average total SFS score of the patients was 103.25±25.09 points, indicating an intermediate level of social functioning. Average total ISMI score of patients was 2.92±0.48 points, reflecting a high level of internalized stigma. A negative significant association was observed between the internalized stigma levels and social functioning of patients. These results suggest that rehabilitation of substance users should include counseling services in order to reduce internal perception of stigma and improve their social functioning.

Effectiveness of long-acting injectable risperidone versus oral antipsychotics in the treatment of recent-onset schizophrenia

Long-acting injectable antipsychotics may offer a relevant improvement in treatment adherence in recent-onset psychosis, leading to a decreased rate of hospital readmission, a better rate of clinical remission and improved psychosocial adjustment. The aim of the study was to compare the clinical remission rates, number of hospital readmissions and personal and social functioning after 2 years between patients with recent-onset schizophrenia (<2 years) in treatment with risperidone long-acting injectable (RLAI) and patients with recent-onset schizophrenia receiving oral antipsychotics. This is a case-control study comparing patients with recent-onset schizophrenia who initiated RLAI treatment between 2004 and 2008 (n=26) with a control group matched for age and sex, diagnosed with recent-onset schizophrenia and treated with oral antipsychotics (n=26). Study assessments included sociodemographic variables, the Positive and Negative Syndrome Scale, the Personal and Social Functioning Scale, the number of hospital readmissions and the Andreasen remission criteria. To assess the effect of treatment on each dependent variable, separate generalized estimating equations models were constructed. After 2 years of treatment, and adjusting for educational level, the RLAI group showed a greater reduction in the Positive and Negative Syndrome Scale total scale [mean (SD)=47.7 (12.0) vs. 66.2 (18.5); mean difference =-17.56; 95% confidence interval (CI)=-27.11 to -8.00; P<0.001], as well as in the negative [mean (SD) 14.3 (6.1) vs. 19.4 (6.4); mean difference=-5.02; 95% CI=-8.28 to -1.77; P=0.002] and general psychopathology [mean (SD)=23.4 (6.3) vs. 32.7 (8.1); mean difference=-9.16; 95% CI=-13.3 to -5.03; P<0.001] subscales compared with the oral antipsychotic group. Personal and Social Functioning Scale scores were also higher in the RLAI group [mean (SD)=72.4 (14.8) vs. 59.7 (13.5); mean difference=13.41; 95% CI=5.65-21.18; P<0.001]. Although not statistically significant, there were fewer readmissions (adjusted odds ratio 0.28; 95% CI=0.06-1.35; P=0.114) and more illness remissions (adjusted odds ratio 3.24; 95% CI=0.20-11.93; P=0.077) in the RLAI group. Treatment with RLAI instead of oral antipsychotics in recent-onset schizophrenia might improve clinical symptoms and social functioning. The efficacy of RLAI treatment on remission and readmission rates should be researched further.

Social functioning in first contact mania: Clinical and neurocognitive correlates

PurposeTo study social functioning, and its relationship with clinical and neurocognitive variables, in patients having their first treatment contact for a manic episode. MethodsA total of 55 first contact mania patients, 34 with a first manic episode (FM) and 21 with previously untreated manic episodes (PM), and 110 healthy control subjects matched for age, sex and education to the patient group, completed the Social Functioning Scale (SFS), a self-reported assessment of social functioning. The patients also completed a broad neuropsychological test battery. ResultsBoth patient groups scored significantly lower on self-rated social functioning compared to healthy controls, with PM patients reporting significantly lower functioning than FM patients. There were no significant correlations between clinical symptoms and social functioning. On a trend level, a reduced SFS score was associated with more cannabis use, higher levels of depression and more depressive episodes as well as an earlier age at onset. There was no significant association between social function and neurocognition. ConclusionsSocial dysfunction was present in patients with BD at first treatment contact—the main predictors of which being the severity of clinical symptoms.

Social functioning in urban, predominantly African American, socially disadvantaged patients with first-episode nonaffective psychosis

Background Social functioning impairments develop and accumulate even prior to initial treatment-seeking for first-episode psychosis. This study, the first to examine social functioning in low-income, urban, predominantly African American first-episode patients: (1) assesses the internal consistency of Social Functioning Scale (SFS) subscales in this relatively unique sample; (2) identifies demographic and clinical variables that may be predictive of poor social functioning in this particular population; and (3) assesses changes in SFS scores in a subsample re-assessed six months after initial hospitalization. Methods 109 participants (age, 23.1 ± 4.7 years; 76.1% male; 89.9% African American) hospitalized for a first episode of nonaffective psychosis in an urban, public-sector setting were administered the SFS along with other clinical research instruments. 34 (31.2%) returned for a follow-up clinical research assessment six months after baseline assessment. Associations between the variables of interest were analyzed utilizing independent samples Student's t-tests and Pearson correlations. Results Associations were observed between social functioning domains and negative symptoms ( r = −.21–−.32, p < .05), depressive symptoms ( r = −.20–−.23, p < .05), and general psychopathology symptoms ( r = −.23–−.24, p < .05). No significant differences were found in SFS subscale scores between baseline and six-month follow-up. Conclusions Deficits in social functioning are meaningfully related to several domains of symptoms, and such deficits may be relatively stable in the early course of psychotic disorders. Such findings may inform development of psychosocial interventions targeting social functioning in first-episode patients.

P03-58 - Determinants of social functioning in first-episode schizophrenia. A prospective follow-up study

ObjectivesComparison of social functioning of first-admitted schizophrenic patients with healthy subjects and evaluation of the influence of several socio-demographic and clinical variables on social abilities of patients, 1 month (T1), 13 months after hospitalization (T2) and 4-6 years after T1 (T3).MethodsA group of 74 schizophrenic patients: 46 male and 28 female; age 24.7 ± 6.7 and a control group of matched 52 male and 34 female subjects were enrolled. Social Functioning Scale (SFS), Positive and Negative Syndrome Scale (PANSS), Global Assessment Scale (GAS) and socio-demographic questionnaire were used.ResultsIn all examinations SFS scores in the patients (T1 - 103.4; T2- 104.4; T3- 107.0), were significantly lower than in the healthy controls - 117.0 (p&lt; 0.001). In longitudinal analysis, a mild improvement was observed in T3 SFS score and in its three subscales (p&lt; 0.05). In cross-sectional analysis, better social functioning was associated with female sex, longer education, activity before admission, and better functioning in the pre-admission period. In regression analyses SFS at T2 was predicted by PANSS (27% of the variance) and at T3 by PANSS and duration of psychotic symptoms (20% of the variance).ConclusionsSocial functioning in schizophrenia is disturbed from the onset of the disease and may be mildly improved in the intermediate follow-up. The duration of untreated illness and severity of symptoms after the first admission, are the independent significant determinants of social functioning in early course of schizophrenia.

P03-70 - Prospective study of correlation between psychopathological symptoms and quality of life of patients with first episode of schizophrenia

ObjectivesAnalysis of correlation between psychopathology and quality of life (QoL) of schizophrenic patients during 4-6 years after the first psychiatric hospitalisation.MethodsStudy population included 74 patients. They were assessed at fixed time-points: 1 month and 13 months after the hospitalisation and 4-6 years after the first examination (T1, T2 and T3, respectively). The following instruments were used to assess symptoms, objective and subjective QoL: PANSS (5-factors), Social Functioning Scale (SFS) and WHOQOL.ResultsAt T1, the mean PANSS score was 62.4. Significant deterioration was noticed in all groups of symptoms, with the exception of cognitive functions. The greatest deterioration was observed in the negative symptoms and depression/anxiety. At T1, the mean SFS score was 103.4, while mean overall subjective QoL scored 3.3. During the follow-up period, significant improvement of SFS was noticed, with no meaningful change in WHOQOL and concomitant exacerbation of symptoms. QOL was particularly compromised by negative symptoms and depression/anxiety.Correlation between SFS and negative symptoms varied from -0.61 to -0.76, while those between SFS score and depression/anxiety - from -0.40 to -0.66. Correlation between subjective QoL and negative symptoms as well as depression/anxiety ranged from -0.31 (environment) to -0.64 (physical domain). To a large extent, symptoms were responsible for variance in both SFS and WHOQOL scores.Conclusions1)Clinical course of schizophrenia varied, depending on adopted criteria of evaluation.2)Negative symptoms and depression/anxiety had a particularly deleterious influence on QoL. The role these symptoms varied, depending on time elapsed since the first hospitalisation.

Social functioning and neurocognitive deficits in outpatients with schizophrenia: a 2-year follow-up

Neurocognitive deficits have been associated with the social functioning impairments of patients with schizophrenia. More information is needed about how cognitive status and other variables predict social functioning over defined periods of time. In this study, 72 relatively stable outpatients with schizophrenia were compared between baseline and a 2-year follow-up on measures of social functioning. Patients were also assessed with a battery of neurocognitive tests and the Positive and Negative Syndrome Scale. Results were compared by univariate and multivariate analyses. A total of four out of seven subscales of the Social Functioning Scale (SFS) and the total SFS score did not show a significant change over the 2-year period. On the three SFS subscales that did show a significant change, residual change scores were correlated with better neurocognitive performance at baseline, younger age, and shorter illness duration. For the Multnomah Community Ability Scale, 48.9% of the total score at follow-up was predicted by initial negative symptoms and scores on the Aphasia Screening Test. These results document the independent contribution of demographic variables, negative symptoms, and neurocognitive deficits to the social functioning impairments of individuals with schizophrenia.

The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: the Whitehall II Study.

This study measured the association between socioeconomic status and the eight scale scores of the Medical Outcomes Study short form 36 (SF-36) general health survey in the Whitehall II study of British civil servants. It also assessed, for the physical functioning scale, whether this association was independent of disease. A questionnaire containing the SF-36 was administered at the third phase of the study to 5766 men and 2589 women aged 39 through 63 years. Socioeconomic status was measured by means of six levels of employment grades. There were significant improvements with age in general mental health, role-emotional, vitality, and social functioning scale scores. In men, all the scales except vitality showed significant age-adjusted gradients across the employment grades (lower grades, worse health). Among women, a similar relationship was found for the physical functioning, pain, and social functioning scales. For physical functioning, the effect of grade was found in those with and without disease. Low socioeconomic status was associated with poor health functioning, and the effect sizes were comparable to those for some clinical conditions. For physical functioning, this association may act both via and independently of disease.