Treatment of cognitive impairment has been proposed as an intervention to reduce disability in people with schizophrenia. The Validation of Everyday Real-World Outcomes (VALERO) study was conducted to evaluate functional rating scales and to identify the rating scale or scales most robustly related to performance-based measures of cognition and everyday living skills.
Adults with schizophrenia (N=198) were tested with the neurocognitive measures from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, the UCSD Performance-Based Skills Assessment-Brief Version, and the advanced finances subscale of the Everyday Functioning Battery. They and an informant (a friend, relative, clinician, or case manager) also reported their everyday functioning on six rating scales. Best judgment ratings were generated by an interviewer who administered the rating scales to patients and informants.
Statistical analyses developed an ability latent trait that reflected scores on the three performance-based (i.e., ability) measures, and canonical correlation analysis related interviewer ratings to the latent trait. The overall fit of the model with all six rating scales was good. Individual rating scales that did not improve the fit of the model were systematically deleted, and a final model with two rating scales was fitted to the data. A regression analysis found that the Specific Levels of Functioning Assessment was a superior predictor of the three performance-based ability measures.
Systematic assessments of real-world functioning were related to performance on neurocognitive and functional capacity measures. Of the six rating scales evaluated in this study, the Specific Levels of Functioning Assessment was the best. Use of a single rating scale provides an efficient assessment of real-world functioning that accounts for considerable variance in performance-based scores.
"As a measure of real world functional performance, the Specific Levels of Functioning (SLOF) was used (Schneider and Struening, 1983). As we previously found in the initial phase of the VALERO study (Harvey et al., 2011), everyday functioning rated with multiple rating scales was related to performance-based assessments of cognition and functional capacity. Of those examined, the SLOF was shown to be the best measure of real world functioning due to its optimal individual correlation with the ability measures. "
"The standardized instruments were the Brief Psychiatric Rating Scale (BPRS) (Ventura, Green, Shaner, & Liberman, 1993), the Health of Nation Outcome Scale (HoNOS) (Wing, Beevor, & Curtis, 1998), and the Personal and Social Performance (PSP) scale, a modified version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) (Morosini, Magliano, Brambilla, Ugolini, & Pioli, 2000). The Specific Levels of Functioning (SLOF), recently considered the 'gold standard' in this field (Harvey et al., 2011), was also administered to assess psychosocial functioning and disability. "
"Fourth, some models of empathy include physiological and motor components that are not captured by the QCAE or other self-report measures; future studies may consider whether these can be assessed using self-report. Lastly, we used an interview-based version of the SLOF, which may have lower reliability than the informant version (Harvey et al., 2011). "
[Show abstract][Hide abstract] ABSTRACT: a b s t r a c t Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n ¼52) and healthy comparison (n ¼ 37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocog-nition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocogni-tion and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed.
Psychiatry Research 10/2014; 220(3). DOI:10.1016/j.psychres.2014.08.054 · 2.47 Impact Factor
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