UCSD Performance-Based Skills Assessment Research Articles

The relationship between obsessive-compulsive symptoms and real-life functioning in schizophrenia: New insights from the multicenter study of the Italian Network for Research on Psychoses.

Although obsessive-compulsive disorder (OCD) is highly prevalent in schizophrenia, its relationship with patients' real-life functioning is still controversial. The present study aims at investigating the prevalence of OCD in a large cohort of non-preselected schizophrenia patients living in the community and verifying the relationship of OCD, as well as of other psychopathological symptoms, with real-life functioning along a continuum of OCD severity and after controlling for demographic variables. A sample of 327 outpatients with schizophrenia was enrolled in the study and collapsed into three subgroups according to OCD severity (subclinical, mild-moderate, severe). A series of structural equation modeling (SEM) was performed to analyze in each subgroup the association of obsessive-compulsive symptoms with real-life functioning, assessed through the Specific Levels of Functioning Scale and the UCSD Performance-Based Skills Assessment. Moreover, latent profile analysis (LPA) was performed to infer latent subpopulations. In the subclinical OCD group, obsessive-compulsive symptoms (OCS) were not associated with functioning, whereas in the mild-moderate OCD group, they showed a positive relationship, particularly in the domains of work and everyday life skills. The paucity of patients with severe OCD did not allow performing SEM analysis in this group. Finally, LPA confirmed a subgroup with mild-moderate OCS and more preserved levels of functioning. These findings hint at a positive association between mild-moderate OCD and real-life functioning in individuals with schizophrenia and encourage a careful assessment of OCD in personalized programs to sustain daily life activities.

Validation of the Chinese Version of the Schizophrenia Cognition Rating Scale.

Objective The Schizophrenia Cognition Rating Scale (SCoRS) is an interview-based assessment tool for evaluating the cognitive deficit and daily functioning of patients with schizophrenia. Methods Sixty-eight patients with schizophrenia and 68 age- and sex-matched healthy individuals were recruited to validate the Chinese version of SCoRS in this study. All participants underwent cognitive assessment using the SCoRS, which was verified by the Brief Assessment of Cognition in Schizophrenia (BACS), and the UCSD Performance-based Skills Assessment, Brief Version (UPSA-B). Patients with schizophrenia were additionally assessed using the Positive and Negative Syndrome Scale (PANSS). Results SCoRS ratings reported by patients (SCoRS-S), those reported by the interviewer (SCoRS-I), and SCoRS global scores (SCoRS-G) showed significant correlation with all subscales of the BACS and the UPSA-B. On receiver operating characteristic curve analysis, SCoRS-S, SCoRS-I, and SCoRS-G significantly differentiated patients with schizophrenia from healthy controls. Moreover, SCoRS-S and SCoRS-I ratings showed positive correlation with the negative symptoms and general symptoms of PANSS. Conclusion The Chinese version of SCoRS showed good discriminant, concurrent, and external validity, suggesting that it is a useful and convenient tool for assessment of cognitive function among Mandarin-speaking patients with schizophrenia in clinical practice.

Cognitive gains as a mechanism of functional capacity improvement in schizophrenia: Results from a multi-site randomized controlled trial

Randomized-controlled trials of Cognitive Enhancement Therapy (CET) reveal its impact on cognitive and functional improvements in schizophrenia and serve as an opportunity for causal claims of potential mediational relationships. In order to examine cognitive gains during CET as a mechanism for improving functional capacity, this secondary analysis included 86 outpatients in the early course of schizophrenia from an 18-month randomized-controlled trial of CET. Functional capacity was measured using the Brief UCSD Performance-Based Skills Assessment (UPSA-B) and cognitive performance by the MATRICS Consensus Cognitive Battery (MCCB) and additional measures of social cognition. Mixed-effects models were used to examine the effects of treatment on the UPSA-B changes and mediation through cognitive improvements. Changes in overall cognition proved to be a significant mediator of CET-related gains in functional capacity at mid-treatment and treatment completion. Exploratory models examining separable cognitive domains further found that improvements in attention, theory of mind, and emotion processing significantly mediated CET effects on functional capacity. This study suggests that CET has potential for improving functional capacity in individuals with schizophrenia, and that cognitive improvements partially mediate this relationship. This evidence can be beneficial for guiding more targeted approaches for rehabilitation in this population.

Motor abnormalities are associated with poor social and functional outcomes in schizophrenia

BackgroundUp to 50% of patients with schizophrenia are suffering from motor abnormalities, which may contribute to decreased quality of life, impaired work capacity, and a reduced life expectancy by 10–20 years. However, the effect of motor abnormalities on social and global functioning, as well as, functional capacity is not clear. We hypothesized, that the presence of motor abnormalities is associated with poorer functional outcomes in patients with schizophrenia. MethodsWe collected data on 5 different motor abnormalities in 156 patients suffering from schizophrenia spectrum disorders: parkinsonism, catatonia, dyskinesia, neurological soft signs and psychomotor slowing (PS). Additionally, we used three different scales to evaluate the functional outcomes in these patients: the Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS) which use clinicians' judgment; and one using a performance-based measure of functional capacity, the brief version of the UCSD Performance-based Skills Assessment (UPSA-B). ResultsOur analysis demonstrated that patients with catatonia (all F > 4.5; p < 0.035) and parkinsonism (all F > 4.9; p < 0.027) scored lower on GAF and SOFAS compared to patients without catatonia and parkinsonism. In contrast, no significant difference on functional outcomes between patients with dyskinesia versus without dyskinesia exist in our study. Furthermore, there are statistically significant negative correlations for parkinsonism and PS with GAF, SOFAS and UPSA-B (all tau are at least −0.152, p-value <0.036). We also found significant negative correlations between catatonia and both GAF & SOFAS (all tau are at least −0.203, p-value<0.001) and between NES and SOFAS (tau = −0.137, p-value = 0.033). ConclusionHere, we showed that four of the most common motor abnormalities observed in schizophrenia were associated with at least one of the patients' functional outcomes. The stronger the motor impairment was the worse the global and social functioning. Future studies need to test, whether amelioration of motor abnormalities is linked to improved community functioning.

Age-trends in Cognitive Function and Quality of Life: Sex Differences in a Community Population in Taiwan

Population aging has developed into a significant area of concern in developed countries, especially in relation to the preservation of functional independence and the quality of life (QoL). However, information on the contribution of sex differences in quality of life and cognitive function is scarce. Therefore, this study aimed to investigate potential differences in cognitive function and QoL between males and females. For this study, we recruited 382 healthy subjects aged 19–79 years from communities in Southern Taiwan. Cognitive function and QoL were assessed using the UCSD Performance-based Skills Assessment, Brief Version (UPSA-B) and World Health Organization Quality of Life Instruments (WHOQOL-BREF), respectively. The effects of sex, age groups, and interaction of sex and age on the UPSA-B and WHOQOL-BREF scores were examined. We found that the financial and communication domains of the UPSA-B showed declining trends with age in both sexes, although these trends were more obvious in females than in males. In the domain of Physical Capacity, QoL showed an age-increased trend in males, while QoL in the Environment domain showed an age-increased trend in females. Regarding the relationships between cognitive function and QoL, we found that the financial skill and communication skill of UPSA-B was positively correlated to the psychological well-being domain of WHOQOL-BREF, in males of age

Assessment of Cognitive Function, Social Disability and Basic Life Skills in Euthymic Patients with Bipolar Disorder.

Data from the literature suggests the presence of cognitive impairments which persist in the euthymic phase of bipolar disorder (BD) and have significant consequences in regards to psychosocial functioning. 1) to ascertain the cognitive function (CF), social disability (SD) and basic life skills (BLS) of euthymic patients diagnosed with BD, 2) their relationship and 3) to compare CF, SD and BLS in euthymic patients diagnosed with BD to euthymic patients with recurrent major depressive disorder (rMDD). Ninety eight euthymic patients diagnosed either with BD (N=48, mean age 48.79 years, SD = 8.587) or rMDD (N=50, mean age 50.02 years, SD = 9.826) underwent testing using the Brief Assessment of Cognition in Affective Disorders (BAC-A) test, the Sheehan Disability Scale (SDS) and the UCSD performance-based skills assessment (UPSA-brief). Euthymic patients with BD demonstrated significantly lower scores as compared to normal population values in verbal, learning and working memory, verbal fluency, attention and processing speed, affective memory for negative and positive words (p<0.01 each) and motor speed (p<0.05), but not for reasoning/problem solving (p=0.05). Furthermore, their mean total SDS score of 17.60 (SD = 6.450, Sk = -0.833) and its subscale scores were higher, while their UPSA-B total scores were lower (M = 76.01, SD = 17.148, Sk = -0.412). There was a correlation between CF, SD and BLS scores (p<0.01), as well as between BLS and SD scores (p<0.05). The analysis of variance did not however show significant differences between subgroups of patients. Patients with euthymic BD had lower cognitive function, greater social disability and lower basic life skills. There were similar decreases in cognitive and psychosocial function between patients in the euthymic phase of either BD or MDD.

Predicting Real-World Functioning in Schizophrenia: The Relative Contributions of Neurocognition, Functional Capacity, and Negative Symptoms

Neurocognition and functional capacity are commonly reported predictors of real-world functioning in schizophrenia. However, the additional impact of negative symptoms, specifically its subdomains, i.e., diminished expression (DE) and avolition-apathy (AA), on real-world functioning remains unclear. The current study assessed 58 individuals with schizophrenia. Neurocognition was assessed with the Brief Assessment of Cognition in Schizophrenia, functional capacity with the UCSD Performance-based Skills Assessment (UPSA-B), and negative symptoms with the Negative Symptom Assessment-16. Real-world functioning was assessed with the Multnomah Community Ability Scale (MCAS) with employment status as an additional objective outcome. Hierarchical regressions and sequential logistic regressions were used to examine the associations between the variables of interest. The results show that global negative symptoms contribute substantial additional variance in predicting MCAS and employment status above and beyond the variance accounted for by neurocognition and functional capacity. In addition, both AA and DE predict the MCAS after controlling for cognition and functional capacity. Only AA accounts for additional variance in employment status beyond that by UPSA-B. In summary, negative symptoms contribute substantial additional variance in predicting both real-world functioning and employment outcomes after accounting for neurocognition and functional capacity. Our findings emphasize both DE and AA as important treatment targets in functional recovery for people with schizophrenia.

Relationship between disability self-awareness and cognitive and daily living function in schizophrenia

We investigated the relationship between disability self-awareness and cognitive and daily living functions in 49 patients with schizophrenia. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS) self-report was used to identify patient-rated global function. A clinician-rated measure of global function was obtained using the Personal and Social Performance Scale (PSP); disability self-awareness was calculated using two global function scores. The Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) were used to evaluate clinical symptoms, while the MATRICS consensus cognitive battery (MCCB) and the UCSD Performance-based Skills Assessment (UPSA) were applied to assess cognitive and daily living functionality, respectively. The WHODAS scores correlated significantly with the MCCB verbal learning, visual learning, and social cognition domains, and with the UPSA communication domain. The PSP correlated significantly with all MCCB and UPSA domains. Disability self-awareness demonstrated positive correlation with most domains of MCCB and UPSA. The findings of this study indicate that the lower the cognitive and daily living function in patients with schizophrenia, the more positively they perceive their own disability.

Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke

ABSTRACT Background To inform cognitive interventions that target functional capacity for individuals who have survived stroke, an evaluation of predictors of daily functioning is necessary. The current literature is limited regarding identifying the associations between objective cognitive functioning and objective performance of Instrumental Activities of Daily Living (IADLs). Objectives To investigate the relationship between objectively measured cognitive domains/executive functions and performance on an objective measure of IADLs following a stroke. Methods Cross-sectional examination of 52 participants who have survived strokes and completed assessments of immediate memory, visuospatial/constructional skills, language, attention, delayed memory, executive functions (i.e., inhibition and flexibility, concept-formation and problem-solving, abstract thinking, deductive thinking, and verbal abstraction), and a performance-based measure of IADLs (UCSD Performance-based Skills Assessment; UPSA). Results Results indicated significant correlations between the UPSA and immediate memory, visuospatial/constructional skills, language, delayed memory, and executive functions (i.e., concept formation and problem-solving, flexibility of thinking, and verbal abstraction). A hierarchical multiple regression, controlling for age, severity of stroke, side of stroke, and depressive symptoms and including the cognitive measures individually significantly associated with the UPSA, explained approximately 62% of the variance in overall UPSA performance. This regression demonstrated that only language significantly predicted UPSA total score, in the context of multiple variables. Conclusions Cognitive functioning is significantly associated with IADL functioning post-stroke, and considering multiple domains of cognitive functioning together largely explains the performance of IADLs.

Identifying Clinically and Functionally Distinct Groups Among Healthy Controls and First Episode Psychosis Patients by Clustering on EEG Patterns.

ObjectiveThe mismatch negativity (MMN) is considered as a promising biomarker that can inform future therapeutic studies. However, there is a large variability among patients with first episode psychosis (FEP). Also, most studies report a single electrode site and on comparing case–control group differences. Few have taken advantage of the full wealth of multi-channel EEG signals to examine observable patterns. None, to our knowledge, have used machine learning (ML) approaches to investigate neurophysiological derived subgroups with distinct cognitive and functional outcome characteristics. In this study, we applied ML to empirically stratify individuals into homogeneous subgroups based on multi-channel MMN data. We then characterized the functional, cognitive, and clinical profiles of these neurobiologically derived subgroups. We also explored the underlying low frequency range responses (delta, theta, alpha) during MMN.MethodsClinical, neurocognitive, functioning data of 33 healthy controls and 20 FEP patients were collected. 90% of the patients had 6-month follow-up data. Neurocognition, social cognition, and functioning measures were assessed using the NCCB Cognitive Battery, the Awareness of Social Inference Test, UCSD Performance-Based Skills Assessment, and Multnomah Community Ability Scale. Symptom severity was collected using the PANSS. MMN amplitude and single-trial derived low frequency activity across 24 frontocentral channels were used as main variables in the ML k-means clustering analyses.ResultsWe found a consistent pattern of two distinctive subgroups. We labeled them as “better functioning” and “poorer functioning” clusters, respectively. Each subgroup can be mapped onto either better or poorer clinical, cognitive, and functioning profiles. Also, we identified two subgroups of patients: one showed improved MMN and one showed worsening of MMN over time. Patients with improved MMN had better follow-up clinical, cognitive, and functioning profile than those with worsening MMN. Among the low frequency bands, delta frequency appeared to be the most relevant to the observed MMN responses in all individuals. However, higher delta responses were not necessarily associated with a better functioning profile, suggesting that delta frequency alone may not be useful in clinical characterization.ConclusionsThe ML approach could be a robust tool to explore heterogeneity and facilitate the identification of neurobiological homogeneous subgroups in FEP.

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

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

Online Social Cognition Training in Schizophrenia: A Double-Blind, Randomized, Controlled Multi-Site Clinical Trial.

Social cognition (SC), the mental operations underlying social functioning, are impaired in schizophrenia. Their direct link to functional outcome and illness status have made them an important therapeutic target. However, no effective treatment for these deficits is currently applied as a standard of care. To address this need, we have developed SocialVille-an online, plasticity-based training program that targets SC deficits in schizophrenia. Here we report the outcomes of a double-blind, controlled, randomized, multi-site clinical trial of SocialVille. Outpatients with schizophrenia were randomized to complete 40 sessions of either SocialVille (N = 55 completers) or active control (computer games; N = 53 completers) from home. The a priori co-primary outcome measures were a social cognitive composite and a functional capacity outcome (UCSD Performance-based Skills Assessment [UPSA-2]). Secondary outcomes included a virtual functional capacity measure (VRFCAT), social functioning, quality of life, and motivation. Linear mixed models revealed a group × time interaction favoring the treatment group for the social cognitive composite (b = 2.81; P < .001) but not for the UPSA-2 measure. Analysis of secondary outcome measures showed significant group × time effects favoring the treatment group on SC and social functioning, on the virtual functional capacity measure and a motivation subscale, although these latter findings were nonsignificant with FDR correction. These results provide support for the efficacy of a remote, plasticity-based social cognitive training program in improving SC and social functioning in schizophrenia. Such treatments may serve as a cost-effective adjunct to existing psychosocial treatments. Trial Registration: NCT02246426.

M219. OVERESTIMATING FUNCTION – A RISK FACTOR FOR SUBOPTIMAL COMMUNITY AID IN SCHIZOPHRENIA

BackgroundPatients with schizophrenia have difficulties in judging their own performance. Patients with no or little practical experience of demands from active performance in society tends to overestimate their ability. Research has also found that patients who overestimate their function also runs a risk to be perceived as better functioning than what they actually are when judged by caregivers. The aim with this study is to examine if patients who overestimate their ability will receive less community support compared to patients who have an accurate perception of their ability?MethodsThe study population was 184 patients with schizophrenia spectrum disorder. They were tested with the Swedish version of the UCSD Performance-based Skills Assessment–Brief Version (UPSA-B). Before the test they were asked how they thought their functioning were in four different domains covered in the UPSA-B. After the test they were divided into four groups: “Good functioning with realistic perception”, “Good functioning but underestimating their function”, “Impaired function with realistic perception” and “Impaired function but overestimating their performance”. The amount of received community support were investigated and related to patients′ actual performance and self-perception.ResultsAnalyzes showed that patients who had an impaired function and a realistic view of their ability had more support than those who were impaired but overestimated their ability. Also, patients with good functioning but underestimating their performance had more support than those who had a good ability and a realistic perception. Finally, there were no difference in community support to the patients in the two groups “Good function with realistic perception” and “Impaired function but overestimating their performance”.DiscussionOur results indicate that patients with impaired functioning who overestimate their ability risk an insufficient community support. This in combination with earlier findings, that staff-members in psychiatric out-patient settings are likely to base their judgement on patients′ report consequential leading to false positive conclusions, may have both short- and long-term implications. Not achieving symptomatic remission, as a consequence of inability to follow medical prescriptions, and sub-optimal social functioning with isolation are two possible implications. The findings once again raises the need for the testing of patients′ function instead of only conducting interviews.

The UCSD Performance-based Skills Assessment Primarily Measures Attention, Executive Function, and Memory in Parkinson’s Disease (1081)

The UCSD Performance-based Skills Assessment Primarily Measures Attention, Executive Function, and Memory in Parkinson’s Disease (1081)

Effects of an extrinsic motivator on the evaluation of cognitive and daily living functions in patients with schizophrenia

We investigated the effect of an extrinsic motivator on the MATRICS Consensus Cognitive Battery (MCCB) and UCSD Performance-Based Skills Assessment (UPSA) scores, which assess cognitive and daily living functions, in patients with schizophrenia. We enrolled 60 clinically stable patients with schizophrenia and allocated them to the motivator or control group. We conducted baseline assessments of cognitive function using the MCCB, daily living function using the UPSA, clinical symptoms, and psychosocial characteristics in both groups. In the retrial, we initially evaluated clinical symptoms. Next, we assigned an extrinsic motivator to the motivator group and again assessed cognitive function and daily living function using the MCCB and UPSA. Statistical analyses were performed using t-tests, Chi-square tests, Fisher's exact test, repeated measures analysis of variance, and logistic regression analysis. We found significant time × group interactions in processing speed, verbal learning, visual learning, and composite scores of MCCB. There were no significant interactions in UPSA scores. The meaningful change rates of social cognition and composite scores in MCCB were significantly higher in the motivator group than in the control group. After adjusting for additional variables, the extrinsic motivator had a significant effect on the meaningful MCCB composite score change. Conclusively, our findings suggest beneficial effects of extrinsic motivator on the MCCB score in patients with schizophrenia. In the future, the implementation and interpretation of the MCCB considering the motivation is necessary.

Improving social functioning in community-dwelling patients with schizophrenia: a randomized controlled computer cognitive remediation therapy trial with six months follow-up

Computerized cognitive remediation therapy (CCRT) has been found to generally improve cognition among patients with schizophrenia, but its effect on functioning has not been extensively studied. This study addressed this gap in the literature by investigating the effect of CCRT and its long-term efficacy among community-dwelling patients with schizophrenia. 157 Chinese patients with schizophrenia were recruited from communities and randomized to CCRT (n = 78) or treatment as usual (TAU; n = 79) groups for 12 weeks with 4–5 sessions per week. Neurocognition, functioning, and symptoms of participants were assessed at baseline, after treatment, and at the 6 month follow-up. The CCRT group showed significantly greater improvements than the TAU group regarding the MATRICS Consensus Cognitive Battery (MCCB) total score and social cognition score. Significant cognitive benefits for functioning were observed (Personal and Social Performance scale, PSP). Moreover, improvement of the MCCB total score mediated a positive effect on functional capacity (UCSD Performance-based Skills Assessment, UPSA), and mediated decreases in negative symptoms across both groups. CCRT improved social functioning and general cognitive functioning among community-dwelling patients with schizophrenia. These improvements persisted for 6 months after treatment. CCRT also led to improvements in functioning and symptom severity by modulating cognitive functioning.

Defining cognitive and functional profiles in schizophrenia and affective disorders

BackgroundNeurocognitive dysfunction is a common symptom of various major psychiatric disorders, including schizophrenia, major depressive disorder (MDD), and bipolar I disorder (BD). In this study, we investigated whether cognitive profiles and daily skill functioning could effectively differentiate between patients with schizophrenia, MDD, and BD.MethodIn this cross-sectional study, we recruited a total of 63 patients with schizophrenia, 55 patients with MDD, 43 patients with BD, and 92 healthy control subjects. We evaluated participants’ cognitive functions and functional capacity using the Brief Assessment of Cognition in Schizophrenia (BACS) and the UCSD Performance-based Skills Assessment, Brief Version (UPSA-B), respectively. Multivariate analysis of covariance was then adopted to determine inter-group differences in BACS and UPSA-B performance.ResultsThe BACS was capable of differentiating patients with a major psychiatric disorder (schizophrenia, MDD, and BD) from healthy subjects. Furthermore, schizophrenia patients had poorer motor speed performance than patients with affective disorders. The UPSA-B, particularly the financial portion, was able to distinguish schizophrenia patients from other groups. However, we did not observe any differences in UPSA-B performance between patients with mood disorders and the healthy controls. No significant difference between patients with BD and those with MDD were observed in either cognitive function or in functional capacity. The performances of the BACS and the UPSA-B were positively correlated, particularly in the MDD group.ConclusionConsidering overall performance, the BACS and the UPSA-B characterize different endophenotyping profiles in the aforementioned four participant groups. Therefore, the results support the need for comprehensive assessments that target both cognitive function and functional capacity for patients with major psychiatric disorders.

Neural and functional correlates of impaired reading ability in schizophrenia

Deficits in early auditory processing (EAP) are a core component of schizophrenia (SZ) and contribute significantly to impaired overall function. Here, we evaluate the potential contributions of EAP-related impairments in reading to functional capacity and outcome, relative to effects of auditory social cognitive and general neurocognitive dysfunction. Participants included 30-SZ and 28-controls of similar age, sex, and educational achievement. EAP was assessed using an auditory working memory (tone-matching) task. Phonological processing and reading Fluency were assessed using the Comprehensive Test of Phonological Processing and Woodcock-Johnson reading batteries, respectively. Auditory-related social cognition was assessed using measures of emotion/sarcasm recognition. Functional capacity and outcome were assessed using the UCSD Performance-based Skills Assessment and Specific Level of Functioning scale, respectively. fMRI resting-state functional-connectivity (rsFC) was used to evaluate potential underlying substrates. As predicted, SZ patients showed significant and interrelated deficits in both phonological processing (d = 0.74, p = 0.009) and reading fluency (d = 1.24, p < 0.00005). By contrast, single word reading (d = 0.35, p = 0.31) was intact. In SZ, deficits in EAP and phonological reading ability significantly predicted reduced functional capacity, but not functional outcome. By contrast, deficits in reading fluency significantly predicted impairments in both functional capacity and functional outcome. Moreover, deficits in reading fluency correlated with rsFC alterations among auditory thalamus, early auditory and auditory association regions. These findings indicate significant contributions of EAP deficits and functional connectivity changes in subcortical and early auditory regions to reductions in reading fluency, and of impaired reading ability to impaired functional outcome in SZ.

Associations Of Personality Traits With The Capacity-Performance Discrepancy Of Functional Outcome In Patients With Schizophrenia.

ObjectiveFunctional capacity, which indicates one’s ability to perform everyday living tasks, contributes to real-world functional performance in patients with schizophrenia. However, functional capacity is sometimes not comparable with functional performance in clinical settings. We hypothesized that specific personality traits are related to this capacity-performance discrepancy of functional outcome.MethodsThe measures in this study were the UCSD Performance-based Skills Assessment Brief (UPSA-B) for functional capacity, the Social Functioning Scale (SFS) for functional performance, and the Temperament and Character Inventory-140 (TCI-140) for personality traits. A total of 94 stable outpatients with schizophrenia were divided into four groups based on combinations of their UPSA-B and SFS cut-off points, as follows: a high capacity and high performance (HH) group, a high capacity but low performance (HL) group, a low capacity but high performance (LH) group, and a low capacity and low performance (LL) group.ResultsThere were no significant differences in demographics among the four groups. The LH group showed a significantly lower harm avoidance level than the LL group. The HL group showed a significantly lower persistence level than the HH group.ConclusionLower harm avoidance may enhance functional performance, and lower persistence can limit functional performance, regardless of the primary levels of functional capacity in patients with schizophrenia. Novel and individualized psychosocial treatments considering the individual’s personality traits seem to be helpful for maximizing their functional performance in the community.

Evaluation of a plasticity-based cognitive training program in schizophrenia: Results from the eCaesar trial

ObjectiveCognitive impairment in schizophrenia is a core feature of the disorder. Computerized cognitive training has shown promise in pilot studies. A 26-week randomized blinded placebo-controlled trial was conducted to investigate the effect of a novel computerized cognitive training program on cognitive and functional capacity outcomes. MethodThe study followed MATRICS guidelines for the evaluation of interventions designed to improve cognitive function in schizophrenia. Participants (N = 150) were randomized to experimental (computerized cognitive training in a game-like format) or active control (computer games) groups. Training was conducted in-clinic, with an intended training schedule of 5 days per week, 1 h per day, for 26 weeks. Co-primary outcome measures were the MATRICS Consensus Cognitive Battery (MCCB) composite score and the UCSD Performance-Based Skills Assessment (UPSA-2) total score, secondary outcome measures included the Cognitive Assessment Interview (CAI) and the Short-Form-12 Mental Composite Score (SF-12 MCS). Target engagement was assessed with task-learning based assessment. ResultsAt baseline, the groups were well matched. No significant effect of the experimental treatment was seen on the primary or secondary outcome measures compared to the active control. Review of the task learning/target engagement data suggested inadequate target engagement. ConclusionsResults do not support a cognitive or functional capacity benefit from this implementation of a computerized cognitive training program in people with schizophrenia. In future trials, careful consideration is merited of the assessment of task learning/target engagement, the effects of making the cognitive training game-like on motivation, and the implicit effects of trial requirements on participant selection.