Social Functioning Variables Research Articles

Identifying Clusters of Curatively-Treated Esophageal Cancer Patients Using Patient-Reported Outcome Measures at Three Months from Discharge: A Secondary Analysis from a Longitudinal Single Center Study.

This study aims to identify meaningful clusters based on Patient-Reported Outcome Measures (PROMs) in curatively-treated esophageal cancer patients at three months post-discharge. This secondary analysis of a longitudinal single-center study included 46 esophageal cancer patients who underwent curative surgery. Patients were selected based on their completion of PROMs surveys at three months post-discharge, were aged 18 years or older, and had undergone surgical resection (esophagectomy) with or without neoadjuvant chemotherapy and/or radiotherapy. The analysis utilized t-distributed Stochastic Neighbor Embedding (t-SNE) for dimensionality reduction and hierarchical clustering to analyze PROMs data collected three months post-discharge. Clustering was performed on physical, emotional, cognitive, and social functioning variables, symptom burden, and health literacy. Three distinct clusters were identified: Cluster 1 (n = 24) with higher functioning and moderate symptoms, Cluster 2 (n = 14) with moderate functioning, higher symptoms, and lower health literacy, and Cluster 3 (n = 8) with the highest functioning, lowest symptoms, and highest health literacy. Significant differences between squamous cell carcinoma and adenocarcinoma subtypes were observed across several PROMs domains, including critical health literacy, general health status/quality of life, nausea and vomiting, and insomnia. These clusters provide an exploratory framework for tailoring post-operative interventions to enhance patient recovery, which necessitates further confirmatory investigations, including outcomes such as complications and mortality, in the analysis. This study fills a research gap by demonstrating the utility of PROMs in identifying distinct recovery patterns in esophageal cancer patients post-surgery. The findings support the use of PROMs to guide personalized post-operative care, potentially improving patient outcomes and quality of life. Further research is needed to validate these findings in larger, diverse populations.

The Roles of Emotion Regulation and Alexithymia in the Relationship Between Sleep and Social Functioning.

Poor sleep quality has been tied to worse social functioning outcomes, including greater loneliness, fewer social interactions, and lower social integration. Other factors likely play a role in the relationship between sleep quality and social functioning. Specifically, alexithymia and emotion regulation may serve as moderators in these relationships. Data for this study came from the Pittsburgh Cold Study 3, a publicly available dataset (N = 213). Participants completed self-report measures including the Pittsburgh Sleep Quality Index, the Emotional Regulation Questionnaire, Toronto Alexithymia Scale, and four measures of social functioning: Social Network Index, Social Participation Measure, Short Loneliness Scale, and Interpersonal Support Evaluation List for providing support to others. Sleep quality was significantly related to the social functioning variables. Further, the use of the emotion regulation strategy reappraisal significantly moderated the relationship between sleep quality and social participation. Worse sleep quality was related to lower engagement in social activities, only for participants high in use of reappraisal. Additionally, the use of reappraisal significantly moderated the relationship between sleep quality and giving of support. Worse sleep quality was related to less self-reported giving of support to others only for participants high in the use of reappraisal. Results suggest that the use of reappraisal may be an important factor to consider in the relationship between sleep and social functioning. Future work should extend these findings to the general population and a sample of individuals with relevant diagnoses, such as borderline personality or schizophrenia-spectrum disorders.

Co-development of attention deficit hyperactivity disorder and autistic trait trajectories from childhood to early adulthood.

Attention deficit hyperactivity disorder (ADHD) and autism, defined as traits or disorders, commonly co-occur. Developmental trajectories of ADHD and autistic traits both show heterogeneity in onset and course, but little is known about how symptom trajectories co-develop into adulthood. Using data from a population cohort, the Avon Longitudinal Study of Parents and Children, we examined correlations between ADHD and autistic traits across development, using the Social Communication Disorders Checklist and ADHD subscale of the Strengths and Difficulties Questionnaire. We modelled joint developmental trajectories of parent-reported ADHD and autistic traits between 4 and 25 years, then characterised trajectory classes based on sociodemographic, perinatal, psychopathology, cognition and social functioning variables and tested for associations with neurodevelopmental/psychiatric polygenic scores (PGS). Three classes of trajectories were identified; a typically developing majority with low-stable ADHD-autistic traits (87%), a male-predominant subgroup with child/adolescent-declining traits (6%) and a subgroup with late-emerging traits (6%). ADHD-autistic trait correlations were greatest in young adulthood for the two nontypically developing classes. There were higher rates of emotional and conduct problems, low IQ, childhood seizures and poor social functioning in the declining and late-emerging classes compared to the low-stable class. Emotional, conduct and peer problems were more prevalent during childhood in the childhood/adolescent-declining class compared to other classes, but were more prevalent in young adulthood in the late-emerging class. Neurodevelopmental/psychiatric PGS also differed: both nontypically developing classes showed elevated ADHD PGS compared to the low-stable group, and the late-emerging group additionally showed elevated schizophrenia PGS and decreased executive function PGS, whereas the declining group showed elevated broad depression PGS. Distinct patterns of ADHD-autism co-development are present across development in the general population, each with different characterising factors and genetic signatures as indexed by PGS.

Anxiety and Social Functioning: The Moderating Roles of Family Accommodation and Youth Characteristics.

It is well established that anxiety can contribute to social functioning difficulties during childhood and adolescence. It is less clear which anxious youth are most likely to struggle socially, and what types of difficulties they are likely to experience, limiting the extent of identification and intervention efforts. In this study, we aim to improve specification of the linkages between youth anxiety severity and social functioning by examining several potential moderators of these associations. Specifically, we examine whether family accommodation of youth anxiety, in addition to youth age, sex, and the presence of a social anxiety disorder diagnosis, influence associations between anxiety severity and social functioning among youth with anxiety disorders. Youth (N = 158, Mage = 9.99years, SD = 2.74) and their mothers completed diagnostic interviews and questionnaires assessing anxiety and depression symptoms, family accommodation, and a range of social functioning variables. In a series of hierarchical linear regressions, we found that youth anxiety severity was most strongly associated with social impairment at high levels of family accommodation for adolescents and for youth without social anxiety disorder (mother-report). We also found several direct effects of anxiety severity, family accommodation, and youth age, sex, and diagnosis on different facets of youth social functioning (youth- and/or mother-report). We discuss clinical implications and future research directions focused on specifying the nature of associations between youth anxiety and their social functioning.

Greater Social Competence Is Associated With Higher Interpersonal Neural Synchrony in Adolescents With Autism.

Difficulty engaging in reciprocal social interactions is a core characteristic of autism spectrum disorder. The mechanisms supporting effective dynamic real-time social exchanges are not yet well understood. This proof-of-concept hyperscanning electroencephalography study examined neural synchrony as the mechanism supporting interpersonal social interaction in 34 adolescents with autism spectrum disorder (50% female), age 10–16 years, paired with neurotypical confederates of similar age. The degree of brain-to-brain neural synchrony was quantified at temporo-parietal scalp locations as the circular correlation of oscillatory amplitudes in theta, alpha, and beta frequency bands while the participants engaged in a friendly conversation. In line with the hypotheses, interpersonal neural synchrony was significantly greater during the social interaction compared to the baseline. Lower levels of synchrony were associated with increased behavioral symptoms of social difficulties. With regard to sex differences, we found evidence for stronger interpersonal neural synchrony during conversation than baseline in females with autism, but not in male participants, for whom such condition differences did not reach statistical significance. This study established the feasibility of hyperscanning during real-time social interactions as an informative approach to examine social competence in autism, demonstrated that neural coordination of activity between the interacting brains may contribute to social behavior, and offered new insights into sex-related variability in social functioning in individuals with autism spectrum disorders.

The Relationship Between Loneliness and Positive Affect in Older Adults

To establish whether positive affect (PA) is uniquely associated with loneliness and other social functioning variables beyond negative affect (NA) among older adults. Four hundred and twenty-eight participants (aged 60+ years old, 82% White, and 48% female) were recruited using random digit-dialing and completed scales for loneliness (UCLA Loneliness Scale), companionship (PROMIS scale), satisfaction with discretionary social activities (PROMIS scale), PA (Center for Epidemiologic Studies [CES] Happiness Scale), and NA (CES-Depression scale and Brief Symptom Inventory-Anxiety Subscale). Multiple linear regression models found PA to be a significant predictor of lower loneliness where the effect of PA on loneliness is dependent on the level of NA; a large effect size at the mean level of NA, which becomes attenuated when NA increases. Although the direction of effect of PA on loneliness will change for NA > 5.10, which is 5 standard deviations away from 0, based on the model estimates, the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with lower loneliness, however this effect is attenuated for larger NA. Similarly, multiple linear regression models found that companionship was associated with PA and NA where the effect of PA is dependent on the level of NA; a medium effect size at the mean level of NA, which becomes attenuated when NA increases. As in the case of loneliness, the direction of effect of PA on companionship will change for NA > 3.52, which is 3.5 standard deviation away from 0, based on the model estimates, but the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with increased companionship, aand this effect is attenuated with greater NA. Satisfaction with social activities was associated with PA only (medium effect size). Results suggest PA appears to be uniquely associated with social functioning among older adults. These findings support the potential for treatments that target PA to decrease loneliness among older adults, or vice versa.

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

Family and social functioning in adults with hoarding disorder

Abstract Hoarding is associated with problems engaging in social activities, lower social support, increased isolation and poses substantial challenges to family functioning. The aim of this investigation was to explore the relationship between hoarding severity and family and social functioning variables in 60 treatment-seeking adults with hoarding disorder (HD). Participants completed a battery of self-report measures during a baseline assessment completed prior to treatment. Forty-seven percent of participants reported they live alone. Forty-eight percent of participants reported that family and friends never visit them in their home, and 33% indicated they never had visitors to their home, not even service workers or repair people. Twelve percent of participants indicated they never visit with family or friends outside of their home; however, 55% of participants endorsed phoning family or friends more than 9 times each month. Increased clutter and hoarding severity was associated with a lower frequency of family and friends visiting in the home. Family competence and conflict were both positively associated with hoarding severity. Our results shed light on family and social impairment in HD and their relationship with symptom severity; however, additional research should examine social dysfunction among non-treatment-seeking individuals who may be more impaired or isolated.

Simulation and social behavior: an fMRI study of neural processing during simulation in individuals with and without risk for psychosis.

Social dysfunction is a risk indicator for schizophrenia spectrum disorders, with at-risk individuals demonstrating a range of social behavior impairments. Variability in social ability may be explained by individual differences in the psychological processes of social behavior. In particular, mental simulation, the process by which an individual generates an internal representation of the thoughts or feelings of another, may explain variation in social behavior. This study investigates the neural process of simulation in healthy individuals and individuals at risk for psychosis. Using a novel fMRI pain paradigm, individuals watch videos of another person’s hand or foot experiencing pain. After each video, individuals are asked to simulate the observed painful situation on their own hand or foot. Neural activity during simulation in the somatosensory cortex was associated with real-world self-reported social behavior, such that a stronger neural response in the somatosensory cortex was associated with greater rates of positive social experiences and affective empathy across all participants. These findings suggest that the neural mechanisms that underlie simulation are important for social behavior, and may explain individual variability in social functioning in healthy and at-risk populations.

S228. TOWARD EARLY DETECTION OF TREATMENT RESISTANT SCHIZOPHRENIA: PREDICTIVE INFORMATION ON NON-RESPONSE TO ANTIPSYCHOTICS BY EVALUATION OF A FEW CLINICAL FACTORS: A STUDY BY ROC CURVE ANALYSIS AND CONFIRMATORY MULTIVARIATE ANALYSIS

BackgroundTreatment Resistant Schizophrenia (TRS) is associated to poor prognosis and highly disabling course. Early detection of the condition is crucial to rapidly provide targeted interventions. The aim of this study was to evaluate whether it may be possible to distinguish TRS from Antipsychotic Responder Schizophrenia (ARS) patients on the basis of a limited number of measurable clinical factors.Methods60 out of 182 eligible patients were included. A multistep diagnostic procedure to separate TRS from ARS was then used. Clinical parameters were recorded. Rating scales were administered, including: the Neurological Evaluation Scale (NES); the Positive and Negative Syndrome Scale (PANSS); the Heinrichs’ Quality of Life Scale (QLS); the UCSD Performance-Based Skills Assessment (UPSA); the Personal and Social Performance (PSP) scale and Specific Level of Functioning (SLOF).We used the Receiver Operating Characteristic (ROC) curves analysis to distinguish between TRS and ARS. Confirmatory logistic regression and discriminant analysis were additionally used.ResultsAmong clinical and demographic parameters, AUCs were significant for previous hospitalizations (AUC=.71; p=.004; SE= .068); antipsychotic dose (AUC=.73; p=.002; SE=.66); duration of illness (AUC=.67; p=.02; SE=.71) and NES score (AUC=.77; p<.0005; SE=.062). Moreover, significant AUCs were found for PANSS Negative subscale score (AUC=.68; p=.013; SE=.068); PANSS total score (AUC=.64; p=.05; SE=.071); QLS score (AUC=.73; p=.003; SE=.067); PSP score (AUC=.69; p=.012; SE=.68); all SLOF areas (AUC ranging from .76 to .68, p<.05), with the exclusion of Area4. A trend toward significance was found for Problem Solving (AUC=.63; p=.08). Among the whole significant variables, the highest specificity for diagnosis was found for NES score and previous hospitalizations (75% and 78.1%, respectively); the highest sensitivity for NES score (71.4%). Accordingly, Odds Ratio of being categorized as TRS were larger for NES score <21.5 (7.5), QLS score <57 (5.49), previous hospitalizations >1.45 and SLOF Area5 <43.5 (4.76 both).Multivariate analysis supported results of ROC curve analysis. Stepwise logistic regression showed that the following variables were significant predictors of TRS/ARS status: previous hospitalizations, NES score, and antipsychotic dose among clinical variables (χ(3)=27.25, p<.0005, Nagelkerke R2=.48); PANSS Negative subscale score among psychopathology variables (χ(1)=7.75, p=.005, Nagelkerke R2=.16); QLS score among quality of life variables (χ(1)=7.91, p=.005, Nagelkerke R2=.16); SLOF Area2 among social functioning variables (χ(1)=18.05, p<.0005, Nagelkerke R2=.34).The descriptive discriminant analysis function was significant for clinical variables, χ(6)=23.84, p=.001. The most relevant discriminator variables in this group were NES score, antipsychotic doses, and previous hospitalizations. Discriminant function was also significant for SLOF variables χ(6)=17.67, p=.007, with Area1 and Area3 scores ensuring the highest discriminative power. Discriminant function was only weakly significant for psychopathology and for quality of life variables (PANSS Negative subscale score and QLS score showed the highest discriminative power, respectively).DiscussionTherefore, the evaluation of a few clinical factors may give solid and predictive information about patient potential to be responsive or non-responsive to antipsychotics. A patient exhibiting a combination of 2 or more lifetime hospitalizations; high NSS; high negative symptoms; low quality of life and psychosocial functioning has low possibility (less than approximately 20%, according to our data) to be responsive to antipsychotic agents.

Greater Pupil Size in Response to Emotional Faces as an Early Marker of Social-Communicative Difficulties in Infants at High Risk for Autism.

When scanning faces, individuals with autism spectrum disorder (ASD) have shown reduced visual attention (e.g., less time on eyes) and atypical autonomic responses (e.g., heightened arousal). To understand how these differences might explain sub-clinical variability in social functioning, 9-month-olds, with or without a family history of ASD, viewed emotionally-expressive faces, and gaze and pupil diameter (a measure of autonomic activation) were recorded using eye-tracking. Infants at high-risk for ASD with no subsequent clinical diagnosis (HRA-) and low-risk controls (LRC) showed similar face scanning and attention to eyes and mouth. Attention was overall greater to eyes than mouth, but this varied as a function of the emotion presented. HRA- showed significantly larger pupil size than LRC. Correlations between scanning at 9 months, pupil size at 9 months, and 18-month social-communicative behavior, revealed positive associations between pupil size and attention to both face and eyes at 9 months in LRC, and a negative association between 9-month pupil size and 18-month social-communicative behavior in HRA-. The present findings point to heightened autonomic arousal in HRA-. Further, with greater arousal relating to worse social-communicative functioning at 18 months, this work points to a mechanism by which unaffected siblings might develop atypical social behavior.

Sex Differences in Social Perception in Children with ASD

Autism spectrum disorder (ASD) is more common in males than females. An underrepresentation of females in the ASD literature has led to limited knowledge of differences in social function across the sexes. Investigations of face perception represent a promising target for understanding variability in social functioning between males and females. The current study analyzed electrophysiological brain recordings during face perception to investigate sex differences in the neural correlates of face perception and their relationship to social function. Event related potentials (ERP) were recorded from children with ASD while viewing faces, inverted faces, and houses. Relative to males, females showed attenuated response at an ERP marker of face perception, the N170. Among females, but not males, atypical face response was associated with symptom severity. Observed sex differences reflect influential differences in social information processing, and impairment in these features correlates with deficits in social information processing in females, but not males, with ASD. These findings hold significance for future treatment protocols, which should account for differences in males and females with ASD in clinical presentation and neural phenotypes.

Therapeutic relationships in vocational rehabilitation: Predicting good relationships for people with psychosis

Therapeutic relationships between clients and vocational rehabilitation workers have been shown to predict entering competitive employment. We aimed to determine predictors of good relationships, using data from an international randomized controlled trial of supported employment (n=312). Baseline predictors of early therapeutic relationships with vocational workers were assessed, along with the impact of vocational status and changing clinical and social functioning variables on relationship ratings over time. Associations between client and professional relationship ratings were also explored. Better early client-rated therapeutic relationship was predicted by better baseline relationship with the clinical keyworker, being in the Individual Placement and Support (IPS) service, the absence of work history and a greater proportion of care needs being met, whereas over time it was predicted by being in the IPS service. Professional-rated early relationship was predicted by social disability and remission, while over time it was predicted by being the same sex as the client, duration of the relationship and the client's increasing anxiety. Client and professional ratings were positively associated but clients' ratings were higher than professionals', particularly in the IPS service. Relationships were better where clients may have been more motivated to engage, including by their prior experience of a good therapeutic relationship with the clinical keyworker.

Asocial beliefs as predictors of asocial behavior in schizophrenia

Poor social and vocational outcomes have long been observed in schizophrenia, and therapeutic outcomes have been modest. Most studies have identified neurocognition and emotion perception as important contributors to social functioning. Recent research has suggested that personal beliefs, attitudes, and expectancies contribute to negative symptoms. However, the impact of specific beliefs and expectancies on social withdrawal in schizophrenia has not been examined. The present study explored: 1. whether asocial beliefs made a significant contribution to social functioning after accounting for neurocognitive performance and emotion perception; and, 2. whether asocial beliefs predicted asocial behavior in a longitudinal design. 123 outpatients diagnosed with schizophrenia or schizoaffective disorder completed tests of neurocognitive performance, emotion perception, asocial beliefs, symptomatology, and functional outcome. A subset of 13 outpatients was retested one year after the initial assessment. Hierarchical regression indicated that asocial beliefs accounted for 18% of the variability in social functioning. Depression and negative symptoms explained another 9% of the dispersion. Contrary to expectations, neurocognition and emotion perception accounted for less than 1% of the variance. In the longitudinal study, baseline asocial beliefs predicted asocial behavior one year later. Asocial beliefs predict poor social functioning in schizophrenia, and may be modifiable by psychological interventions.

Four symptom dimensions in outpatients with schizophrenia

Objective The aim of this study was to assess the dimensional structure of the Positive and Negative Symptoms Scale (PANSS) to identify the psychopathological profiles of outpatients with schizophrenia. Method Two hundred and thirty-one persons with schizophrenia ( DSM-IV criteria) were randomly selected from a register that included all patients under treatment in 5 mental health care centers in Spain. Patients were evaluated with a sociodemographic and clinical questionnaire, the PANSS, the Disability Assessment Scale short version, and the Global Assessment Functioning Scale. A principal component analysis with oblimin rotation was used to examine the factor structure of the PANSS. Different statistical analyses were done to compare the resulting factors with clinical, disability, and social functioning variables. Results Mean age of patients included was 39.6 years and approximately 65% were male. Four principal components, each of them with eigenvalues greater than 1.5, accounted for 56.22% of the variance. After oblimin rotation, these factors were identified as the Negative (32.48%), Excitement (11.29%), Affective (7.45%), and Positive (5.01%) components. Significant positive correlation between age and the negative dimension was found. Also, we observed significant negative correlations between global assessment functioning and negative and positive dimensions. Total disability was significantly positively related to all dimensions. Conclusion Positive and negative dimensions are common in all principal component analysis results, but we also found affective and excitement dimensions. The present finding suggests that further investigation of symptom dimensions may help to improve symptom-specific treatments; future research should focus on the design of new treatment programs considering these results.

Main determinants of Global Assessment of Functioning score in schizophrenia: a European multicenter study

Background The Global Assessment of Functioning (GAF) scale is a measure widely used to assess the outcome of patients with schizophrenia. However, little is known about the importance of clinical and psychosocial variables in determining its final score. The aim of this paper is to identify which factors predict GAF scores of patients with schizophrenia and their variability in 5 different European settings. Method A representative sample of 404 patients with schizophrenia was assessed with the GAF. A multiple regression analysis was performed to identify predictors of the GAF scores. Results Clinical factors are the main determinants of GAF score. However, the analysis also showed that social and functioning factors were also significantly associated with GAF scores. Finally, the study showed the presence of intercenter differences in the factors, mainly in social functioning. Conclusions The GAF is a useful and easy-to-apply measure of global functioning, independent of cross-cultural differences. Clinical factors are the main determinants of its score, although social functioning variables also have a lesser effect.

Four behavioural syndromes of schizophrenia: a replication in a second inner-London epidemiological sample

In a previous large epidemiological survey of patients with strictly defined schizophrenia in the London borough of Camden, we extracted four behavioural syndromes (Social withdrawal, Thought disturbance, Anti-social behaviour and Depressed behaviour) by factor analysis of MRC Social Behaviour Schedule (SBS) data. These syndromes had significant differential relationships to symptoms assessed using the Manchester Scale (MS), symptom-derived syndromes, and social functioning variables. A second inner-London epidemiological survey of schizophrenia in South Westminster using identical methodology found the same four behavioural syndromes with identical core component items. The same four behavioural syndromes were extracted, whether applying strict Feighner diagnostic criteria ( n=112) or broader DSM-III-R criteria ( n=198). The four syndromes extracted from the Feighner positive sample showed relationships to symptoms and social functioning variables similar to those found in the original Camden study. However, the symptom-derived factors were not the same and did not conform to the three recognised symptom-based syndromes of schizophrenia. This successful replication suggests that assessment of the four behavioural syndromes of schizophrenia offers a different perspective on disability and a potentially relevant measure in clinical practice, clinical trials and studies of the neuropsychology and pathophysiology of schizophrenia.

Neurocognitive deficits and social functioning in outpatients with schizophrenia

Previous studies suggest that neurocognitive factors may contribute to the reduced social functioning of patients with schizophrenia. To assess this relationship, we administered a battery of neurocognitive tests and independently assessed symptoms (PANSS) and social functioning (SFS) in 88 stable outpatients with schizophrenia. We found a significant correlation between neurocognitive and social functioning variables. Patients' performance on aphasia, spatial organization and visual spatial tasks was correlated with their competence at activities of daily living, frequency of social activities and total social functioning. Regression analyses of each social functioning scale revealed different symptom and neurocognitive predictors. Patients' overall social functioning was best predicted by a combination of negative symptoms and aphasia. The results support the potential use of interventions to reduce patients' cognitive deficits as a means to improve their social outcomes.

Four behavioural syndromes of schizophrenia.

A complementary approach to defining symptomatic subtypes of schizophrenia is to identify characteristic patterns of 'problem behaviours' associated with the capacity of patients to function in the community. In a large epidemiological survey, patients fulfilling Feighner criteria for schizophrenia were identified by key informants and assessed using the MRC Social Behaviour Schedule (SBS) and the Manchester Scale. An exploratory factor analysis was used to extract behavioural syndromes from the SBS data in order to compare the syndrome profiles in community, acute and long-stay subgroups and to examine their associations with symptoms and social functioning. Four behavioural syndromes were identified: 'Thought disturbance', 'Social withdrawal', 'Depressed behaviour' and 'Anti-social behaviour', which distinguished between the patient subgroups and had significant differential relationships to symptoms and social functioning variables. The evaluation of disability in schizophrenia and effectiveness of treatment interventions is incomplete without an assessment of problem behaviours.

Four behavioural syndromes of schizophrenia

BACKGROUND A complementary approach to defining symptomatic subtypes of schizophrenia is to identify characteristic patterns of 'problem behaviours' associated with the capacity of patients to function in the community. METHOD In a large epidemiological survey, patients fulfilling Feighner criteria for schizophrenia were identified by key informants and assessed using the MRC Social Behaviour Schedule (SBS) and the Manchester Scale. An exploratory factor analysis was used to extract behavioural syndromes from the SBS data in order to compare the syndrome profiles in community, acute and long-stay subgroups and to examine their associations with symptoms and social functioning. RESULTS Four behavioural syndromes were identified: 'Thought disturbance', 'Social withdrawal', 'Depressed behaviour' and 'Anti-social behaviour', which distinguished between the patient subgroups and had significant differential relationships to symptoms and social functioning variables. CONCLUSIONS The evaluation of disability in schizophrenia and effectiveness of treatment interventions is incomplete without an assessment of problem behaviours.