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SLOF: A behavioral rating scale for assessing the mentally ill
Abstract
Rating scales for assessing the mentally III usually focus on the role functioning of clients and their psychiatric symptomatology.
This article introduces a rating scale to measure more directly observable behavioral functioning and daily living skills
of clients in mental hospitals and in the community. Results are presented from a series of studies designed to test the instrument's
psychometric properties.
... Similar to the LQoLI, the CIS includes a sub-test of physical community integration, which measures meaningful activities in which a person may participate outside of the home such as going to a restaurant or café or participating in sports or recreation (Aubry & Myner, 1996). Other standardized measures of meaningful activity participation used in included studies were the Australian Occupational Therapy Outcome Measure (AusTOMs-OT) (Unsworth & Duncombe, 2014), the Volitional Questionnaire (VQ) (de las Heras et al., 1998), the Quality of Life Rating Scale (QOLRS) (Gust, 1982), the Meaningful Activity Participation Assessment (MAPA) (Eakman et al., 2010), a modified version of the Perceived Improvement Questionnaire (PIQ) (Perreault et al., 2010), the Scale for Level of Functioning (SLOF) (Schneider & Struening, 1983) and the Multnomah Community Ability Scale (MCAS) (Barker et al., 1994). ...
... The Hostel Outreach Program comprised case managers providing outreach to unhoused individuals who were receiving support from emergency shelters using an assertive engagement approach (Wasylenki et al., 1993). The authors used the activity subscale of the SLOF (Schneider & Struening, 1983) to measure participation in meaningful activities over an 18-month period. Across this time frame, participants reported a statistically significant increase in meaningful activity participation on the SLOF, with particular improvements reported in personal care (p < .001) ...
Background. Meaningful activity participation has been identified as a key outcome of services designed to support individuals during and following homelessness. Little is known about the effectiveness of interventions for promoting this outcome. Purpose. To identify the range and effectiveness of interventions on promoting meaningful activity participation among persons with experiences of homelessness. Method. We conducted a systematic review using the Joanna Briggs Institute methodology following PRISMA guidelines including a critical appraisal and narrative synthesis. Findings. Of 12,343 titles and abstracts screened, we included 12 studies. The authors of the included studies primarily used standardized measures of meaningful activity engagement. Critical appraisal scores ranged from 50.0 to 77.8. The most common interventions evaluated in the included studies were psychosocial interventions ( n = 6; 50.0%), followed by case management and housing support interventions ( n = 4; 33.3%) and Housing First ( n = 2; 16.7%). While several interventions demonstrated effectiveness in promoting meaningful activity participation including psychosocial and case management interventions, Housing First, Critical Time Intervention, and a peer support intervention were found to be ineffective for promoting engagement in meaningful activity. Conclusion. Few intervention studies have been conducted that demonstrate effectiveness for promoting participation in meaningful activity for individuals during and following homelessness. Occupational therapy researchers and practitioners can build on existing evidence by developing and evaluating novel approaches by co-designing interventions in collaboration with persons with experiences of homelessness and service providers.
... SLOF patrí v zahraničí k často používaným sebaposudzovacím dotazníkom na meranie sociálneho fungovania pre osoby so psychickými poruchami. 25 Nástroj bol pôvodne vytvorený ako pomôcka pre zdravotnícky personál k plánovaniu liečebnej intervencie ľudí so schizofréniou. Úspešne sa ale používa aj pri iných psychických poruchách, napríklad pri depresii a bipolárnej poruche. ...
... Dotazník vykazuje dobré psychometrické vlastnosti, prediktívnu validitu, vysokú vnútornú konzistenciu, aj zhodu posudzovateľov. 25,26 V rámci projektu VALERO, v ktorom sa snažili identifikovať nástroje pre hodnotenie funkčnosti, bol SLOF taktiež hodnotený vysoko pozitívne. 6 Slovenská verzia škály bola úspešne použitá v menších projektoch, ale validizačná štúdia na väčšej vzorke nebola realizovaná. ...
Narušenie funkčnosti patrí k základným charakteristikám klinického obrazu pri po-ruchách schizofrenického spektra a spra-vidla pretrváva aj po odznení akútnej fázy ochorenia. Vzhľadom na viacdimenzio-nálny charakter funkčnosti existuje široké množstvo metód, ktoré slúžia na hodno-tenie rôznych aspektov funkčnosti. Niek-toré metódy sa zameriavajú na meranie pracovnej či školskej oblasti, iné na voľno-časové aktivity, prípadne medziľudské a partnerské vzťahy, dôležitými oblasťami funkčnosti sú aj starostlivosť o domácnosť a starostlivosť o seba. Okrem hodnotenia prítomnosti a rozsahu narušenia funkčnosti je dôležité sledovanie zmien v sociálnom fungovaní u pacientov, napríklad ako uka-zovateľa úspešnosti farmakoterapie alebo účinnosti psychosociálnej rehabilitácie. Cieľom práce je popísať funkčnosť pri schi-zofrénii so zameraním na súčasné metódy jej hodnotenia. Postupne priblížime rôzne spôsoby hodnotenia funkčnosti od sebapo-sudzovacích dotazníkov po objektívne šká-ly. Zároveň priblížime aj nové prístupy, ako hodnotenie funkčnej kapacity a Experience sampling method. V závere ilustrujeme po-treby implementácie rutinného hodnote-nia funkčnosti do klinickej praxe s dôrazom na sledovanie efektívnosti liečby, potreby valídneho hodnotenia invalidity či vhod-nosti pre zapojenie do psychosociálnych intervencií pre pacientov s poruchami schi-zofrenického spektra.
... scale (Schneider and Struening, 1983) is a 43-item self-reported behavioral survey queried on a five-point scale (1 = not at all, 5 = very much so), with higher scores representing better social functioning. The SLOF has demonstrated adequate reliability and factorial validity in studies assessing functional status in both schizophrenia patients (Bowie et al., 2006(Bowie et al., , 2008Schneider and Struening, 1983) and the general population Oliveri et al., 2020). ...
... scale (Schneider and Struening, 1983) is a 43-item self-reported behavioral survey queried on a five-point scale (1 = not at all, 5 = very much so), with higher scores representing better social functioning. The SLOF has demonstrated adequate reliability and factorial validity in studies assessing functional status in both schizophrenia patients (Bowie et al., 2006(Bowie et al., , 2008Schneider and Struening, 1983) and the general population Oliveri et al., 2020). The SLOF assesses current functioning and behavior across 6 domains: (1) physical functioning, (2) personal care skills, (3) interpersonal relationships, (4) social acceptability, (5) activities of community living, and (6) work skills. ...
Background: Some research suggests that schizotypal and autistic traits can produce opposing effects on the mentalizing domain of social cognition. Although such findings support a diametrical model proposing that psychotic and autistic traits represent opposite extremes of the social brain continuum, results from recent
studies have been more inconsistent, and the applicability of this model to other social cognition domains remains unclear. To test the diametrical model more broadly, this study examined the interactions between schizotypal and autistic traits on emotion recognition and social functioning.
Method: A total of 791 participants recruited from the general population self-reported schizotypal traits using the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR) and autistic traits using the Broad Autism Phenotype Questionnaire (BAPQ). Participants also completed the Emotion Recognition 40 task and the Specific Levels of Functioning (SLOF) scale.
Results: The SPQ subscales of interpersonal relationships and disorganized symptoms interacted significantly with social BAP on overall emotion recognition performance and the accuracy of identifying neutral faces. Supporting the diametrical model, elevated levels of both schizotypal and autistic traits contributed to higher emotion recognition accuracy compared to elevations on only one trait. For social functioning, however, the diametrical model was not supported. A main effect was found such that higher interpersonal relationship difficulties on SPQ predicted lower work skills on SLOF, and higher levels of both schizotypal and autistic traits
combined to produce even lower social functioning.
Conclusions: These findings suggest that the diametrical model may be more relevant to social cognition than to social functioning.
... Multidimensional Scale of Independent Functioning ( Jaeger et al., 2003) Independent functioning in work, education, residential domains, role responsibility, presence and level of support, performance quality Specific Levels of Functioning Scale ( Schneider and Struening, 1983) Physical functioning, personal care skills, interpersonal relationships, social acceptability, activities of community living, work skills A. Ganse-Dumrath et al. Schizophrenia Research: Cognition 40 (2025) 100351 Team, 2021) for meta-mediation analysis. ...
Non-affective psychotic disorders are marked by cognitive and sensory processing abnormalities, including in early visual processing and social cognition. Understanding the relationships between these deficits and their impact on daily-life functional outcomes may help to improve outcomes in affected individuals. This systematic review and meta-analysis aimed to summarise the existing evidence on the relationships between early visual processing, social cognition, and functional outcomes, and to assess the evidence regarding the mediating role of social cognition in the association between early visual processing and functional outcomes in individuals with schizophrenia spectrum disorders. A comprehensive search across five databases identified 364 potentially eligible studies, with eight articles meeting all inclusion criteria. Meta-analytic techniques were employed to synthesise effect sizes and assess a meta-mediation model. Three random-effects meta-analyses revealed significant associations between all three domains of interest. Social cognition partially mediated the relationship between early visual processing and functional outcomes. The direct effect of early visual processing on functional outcomes remained significant, albeit with a reduced effect size. The findings suggest that interventions targeting both early visual processing and social cognition concurrently may improve functional outcomes more effectively than focusing on either domain alone.
... Functional outcome: The Specific Level of Function (SLOF) scale is a 43item interview used to measure functioning [54], and it will be administered to both participants and to their informants as an indicator of both real-world impact of iTEST (e.g., improvements in ratings) and of far transfer (e.g., the increased agreement between participants and informants). The scale assesses the participant's current functioning integrated into a single higher-order factor addressing social, everyday, and vocational activities [55]. ...
Poor introspective accuracy (IA), defined as inaccurate judgments of one’s abilities and performance, is a strong and independent predictor of functional impairment in people with psychotic disorders. However, there are currently no treatments that directly target IA in this population as a primary outcome. We describe a protocol for a clinical trial to test a newly developed blended digital intervention, Improving Thinking through Everyday SelfAssessment Training (iTEST) , aimed at improving IA in people with psychotic disorders to improve functional outcomes. iTEST involves daily training consisting of feedback on IA in mobile cognitive tests, coupled with individual coaching that applies improved IA to participant-identified recovery goals. Following the NIMH experimental therapeutics paradigm, the first step in the evaluation of iTEST is an open trial in 60 individuals with psychotic disorders to assess 1) feasibility and acceptability, and 2) whether the intervention leads to clinically significant improvement in an objective target: IA on trained tasks along with transfer to an untrained task-based measure of IA. After programming of the mobile intervention and the creation of treatment manuals, enrollment for an open trial started in November 2023 and will be completed by April 2025. If effective, iTEST could be integrated with cognitive training and other rehabilitative interventions to boost the impact on functional outcomes. Trial registration: ClinicalTrials.gov NCT05899348.
... The other variables assessed in the present study were psychopathology, assessed by the Positive and Negative Syndrome Scale (PANSS) 47,48 , neurocognition, assessed by the Brief Assessment of Cognition for Schizophrenia, Japanese Version 49,50 , functional capacity, assessed by the University of California, San Diego Performance-based Skill Assessment-Brief (UPSA-B) 51,52 , and social functioning, assessed by the Specific Levels of Functioning Scale (SLOF) with interviewer ratings 53,54 . Except for the case of PANSS, the total score on each scale was used. ...
Intervention for social cognition could be key to improving social functioning in patients with schizophrenia. A first step towards its clinical implementation involves interviewing patients about their subjective difficulties with social cognition as they experience them in the real world. The present study focused on the clinical subtypes classified by the discrepancies between the subjective difficulties in social cognition and actual cognitive impairment. A total of 131 outpatients with schizophrenia and 68 healthy controls were included. Objective measurement of social cognition was performed using a test battery covering four representative domains, and subjective difficulties were determined by a questionnaire covering the same domains. A two-step cluster analysis explored the potential classification of social cognition in patients with schizophrenia. There was little correlation between the objective performance on social cognition tasks and subjective difficulties in social cognition. The analysis yielded three clusters: the low-impact group (low objective impairment and low subjective difficulties), the unaware group (high objective impairment but low subjective difficulties), and the perceptive group (moderate objective impairment and high subjective difficulties). Positive, negative, and general symptoms were more severe in the two groups that showed impaired performance on the social cognition tasks (i.e., the unaware and perceptive groups) than those in the low-impact group. Neurocognition and functional capacity were the lowest in the unaware group, and social functioning was the lowest in the perceptive group. Awareness about the clinical subtypes of social cognition could serve as a guidepost for providing individualized, targeted interventions.
... The Specific Level of Functioning (SLOF) [87,88] Additionally, the assessment included the administration of tasks evaluating abilities of social cognition namely the Facial Emotion Identification Task [90], the Awareness of Social Inference Test [91], the Ambiguous Intentions Hostility Questionnaire [92], and the Mayer-Salovey-Caruso Emotional Intelligence Test-Managing Emotions (MSCEIT-ME) [93], which is part of the MCCB but can be excluded from the neurocognitive composite score. These tests have been previously described (and analyzed) elsewhere [74]. ...
Schizophrenia is a chronic psychiatric disorder severely affecting patients’ functioning and quality of life. Unlike positive symptoms, cognitive impairment and negative symptoms cannot be treated pharmacologically and represent consistent predictors of the illness’s prognosis. Cognitive remediation (CR) interventions have been applied to target these symptoms. Brain stimulation also provides promising yet preliminary results in reducing negative symptoms, whereas its effect on cognitive impairment remains heterogeneous. Here, we combined intermittent theta burst stimulation (iTBS) with CR to improve negative symptoms and cognitive impairment in schizophrenia spectrum patients. One hundred eligible patients were invited, and twenty-one participated. We randomized them into four groups, manipulating the stimulation condition (real vs. sham) and CR (no training vs. training). We delivered fifteen iTBS sessions over the left dorsolateral prefrontal cortex for three weeks, followed (or not) by 50 min of training. Consensus-based clinical and cognitive assessment was administered at baseline and after the treatment, plus at three follow-ups occurring one, three, and six months after the intervention. Mixed-model analyses were run on cognitive and negative symptom scores. The preliminary findings highlighted a marginal modulation of iTBS on negative symptoms, whereas CR improved isolated cognitive functions. We herein discuss the limitations and strengths of the methodological approach.
... The Specific Level of Functioning (SLOF) questionnaire was used to examine the patients' real-world everyday functional performance (Schneider and Struening, 1983). The items are scored on a 5-point Likert scale relating to the frequency of a certain behavior or/and independence level over the past week. ...
Background: Patients with schizophrenia suffer from physical health conditions, culminating in reduced physical functioning with enormous costs for patients and society. Although aerobic endurance and skeletal muscle strength, typically reduced in this population, relate to cognition and function, no study has explored their respective contributions to performance of functional skills and everyday tasks. Methods: In a cross-sectional study, 48 outpatients (28/20 men/women; 35 ± 11(SD) years) with schizophrenia spectrum disorders (ICD-10; F20-25) were administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B; functional skills), Specific Level of Functioning (SLOF; functional performance) and the Positive and Negative Syndrome (PANSS) scale. Peak oxygen uptake (V˙O 2peak) was assessed along with leg press maximal muscle strength (1RM) and mechanical power. Results: UPSA-B performance was associated with V˙O 2peak (r = 0.28,p < 0.05), accounting for 8 % (p < 0.05) of shared variance, but was unrelated to 1RM and mechanical power. The SLOF physical functioning domain was associated with V˙O 2peak (r = 0.30,p < 0.05) and 1RM (r = 0.24,p < 0.05), while SLOF personal care (r = 0.27,p < 0.05) and activities (r = 0.30,p < 0.05) were related only to V˙O 2peak. Hierarchical regression analyses revealed that while V˙O 2peak and age combined to account for 20 % (p < 0.05) of the variance in physical functioning, the contribution of 1RM was eliminated after adjusting for age. V˙O 2peak and negative symptoms combined predicted 24 % and 35 % of the variance in personal care and activities, respectively. UPSA-B scores did not add to the prediction of SLOF scores. Conclusions: Although V˙O 2peak and 1RM both relate to functional outcomes, the combination of V˙O 2peak , age, and negative symptoms exert the greatest detrimental influence on functional performance beyond skills deficits.
... Specific Level of Functioning Scale (SLOF). The 43-item SLOF (Schneider and Struening, 1983) consisted of three domains: physical functioning and personal care (12 items), social functioning (14 items), and community living skills (17 items). The items were rated on a 5-point Likert scale (1, "totally dependent" to 5, "highly self-sufficient"). ...
... The remaining 108 participants included a mixture of clinical (n=87) and community (n=21) participants. Of these, 39 participants were excluded from analyses due to study withdrawal (n=8), MRI safety concerns (n=5), poor t in the scanner (n=3), technical problems (n=8), excessive movement (n=1), or inadequate task compliance (hit-rate <10% during any scan; n=14), yielding a nal sample of 69 individuals ( Table S1) 40,41 . Consistent with prior studies, in the current sample more severe MAP symptoms were associated with poorer interpersonal functioning (r = -.56, ...
Among individuals living with psychotic disorders, social impairment is common, debilitating, and challenging to treat. While the roots of this impairment are undoubtedly complex, converging lines of evidence suggest that social motivation and pleasure (MAP) deficits play a key role. Yet most neuroimaging studies have focused on monetary rewards, precluding decisive inferences. Here we leveraged parallel social and monetary incentive delay fMRI paradigms to test whether blunted reactivity to social incentives in the ventral striatum—a key component of the distributed neural circuit mediating appetitive motivation and hedonic pleasure—is associated with more severe MAP symptoms in a transdiagnostic sample enriched for psychosis. To maximize ecological validity and translational relevance, we capitalized on naturalistic audiovisual clips of an established social partner expressing positive feedback. Although both paradigms robustly engaged the ventral striatum, only reactivity to social incentives was associated with clinician-rated MAP deficits. This association remained significant when controlling for other symptoms, binary diagnostic status, or ventral striatum reactivity to monetary incentives. Follow-up analyses suggested that this association predominantly reflects diminished striatal activation during the receipt of social reward. These observations provide a neurobiologically grounded framework for conceptualizing the social-anhedonia symptoms and social impairments that characterize many individuals living with psychotic disorders and underscore the need to establish targeted intervention strategies.
... -The Clinical Global Impression (CGI) (Guy, 1976), completed by the clinician, was used to assess the current severity of illness on a 7-point Likert scale, where higher rates represent high-severity illness. -The Specific Level of Functioning (SLOF) (Schneider and Struening, 1983;Mucci et al., 2014) ...
Schizophrenia is a severe, chronic mental disorder that profoundly impacts patients’ everyday lives. The illness’s core features include positive and negative symptoms and cognitive impairments. In particular, deficits in the social cognition domain showed a tighter connection to patients’ everyday functioning than the other symptoms. Social remediation interventions have been developed, providing heterogeneous results considering the possibility of generalizing the acquired improvements in patients’ daily activities. In this pilot randomized controlled trial, we investigated the feasibility of combining fifteen daily cognitive and social training sessions with non-invasive brain stimulation to boost the effectiveness of the two interventions. We delivered intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC). Twenty-one patients were randomized into four groups, varying for the assigned stimulation condition (real vs. sham iTBS) and the type of cognitive intervention (training vs. no training). Clinical symptoms and social cognition tests were administered at five time points, i.e., before and after the treatment, and at three follow-ups at one, three, and six months after the treatments’ end. Preliminary data show a trend in improving the competence in managing emotion in participants performing the training. Conversely, no differences were found in pre and post-treatment scores for emotion recognition, theory of mind, and attribution of intentions scores. The iTBS intervention did not induce additional effects on individuals’ performance. The methodological approach’s novelty and limitations of the present study are discussed.
... Functional capacity was measured with the UCSD Performance-based skills assessment (UPSA-2) (Patterson et al., 2001). Additional measures of functioning included the Global Functioning Scale: Social and Role (GFS) (Auther et al., 2006;Niendam et al., 2006), the Quality of Life Scale (QLS) (Heinrichs et al., 1984), the Specific Levels of Functioning Scale (SLOF) (Schneider and Struening, 1983), and the Social Functioning Scale (SFS) (Birchwood et al., 1990). ...
... The Specific Level of Functioning Scale (SLOF) was used to examine the functioning of people with mental illness Schneider & Struening, 1983). The abbreviated version of SLOF includes domains of social functioning (e.g. ...
... Over 50 measures were identified that contained overlapping content with a subdomain, factor, or facet of our conceptual model. For example, we considered measures developed for, or most commonly used in, IDD (i.e., Scales of Independent Behavior-Revised [SIB-R; Bruininks et al., 1996], Waisman Activities of Daily Living [W-ADL; Maenner et al., 2013]), as well as those primarily used in other populations [i.e., Specific Levels of Functioning Scale [SLOF; Schneider & Struening, 1983], Work Behavior Inventory [WBI; Bryson et al., 1997], as well as PROMIS measures in relevant domains. Per PROMIS standards, items from existing measures were incorporated into the item pool only if they could be mapped directly onto our preliminary conceptual model. ...
Employment, social relationships, and autonomy are priorities to people with intellectual and developmental disabilities (IDDs). However, few validated measures exist to systematically assess these key adult outcomes in this population. This research includes first steps to develop self- and proxy report measures of life outcomes for adults with IDDs—the Relationships, Employment, Autonomy, and Life Satisfaction (REALS). A literature search identified existing adult outcome measures, and comparison of their domains informed initial conceptual model development. External consultants revised the model, and items were generated. Autistic adults (n = 15), adults with other IDDs (n = 7), caregivers of autistic adults (n = 13), and caregivers of adults with other IDDs (n = 10) completed in-depth cognitive interviews to assess comprehension of items and response categories, factors influencing how participants respond to items, and the inclusiveness of the item pool. A final conceptual model was generated with three subdomains (social relationships, employment, and autonomy), including assessment of life satisfaction within each domain. Cognitive interviews revealed that response set restructuring and item-level revisions were needed to capture the complexity of adult life and make the measure more accessible across a range of abilities. This study developed a conceptual model of relationships, work, and autonomy specific to adults with IDDs. Future work will involve collecting data from 800 + self-reporters with IDDs and 800 + caregivers of adults with IDDs to conduct psychometric analyses. Improving measurement in this area is critical to better understanding the needs of adults with IDDs and improving services available to them.
... The SLOF has been developed as an interview-based multidimensional assessment measure of social functioning, including interpersonal, vocational, and independent-living domains. 20 Specifically, Harvey et al. 21 found that the SLOF, among other social function scales, best-predicted performance for either neurocognition or functional capacity. ...
The rate of medication persistence was examined in patients with schizophrenia or schizoaffective disorder during switching from previously administered antipsychotics to brexpiprazole, a new dopamine D 2 receptor partial agonist. A multicenter, single‐arm, open‐label 24‐week interventional study was conducted, consisting of two 12‐week consecutive periods: an initial switch (by plateau cross‐titration) with the subsequent period, followed by a second maintenance period. Prior antipsychotics were olanzapine or risperidone/paliperidone. The primary and secondary outcome measures were medication persistence rates after the first 12 weeks and changes from baseline in the Specific Levels of Functioning Scale (SLOF), Subjective Well‐being under Neuroleptic drug treatment Short form (SWNS), and Positive and Negative Syndrome Scale (PANSS) scores, respectively. In total, 79 patients were administered brexpiprazole and the medication persistence rate at 12 weeks was 78.5%, which was significantly higher than the predefined threshold of 65%. Regarding the prior medication, the persistence rate at 12 weeks was 84.6% for olanzapine and 72.5% for risperidone/paliperidone. Significant improvements from baseline were observed in the SLOF, SWNS, and PANSS scores. There were no adverse events of concern. Thus, brexpiprazole appeared to be a suitable antipsychotic on switching from olanzapine, risperidone, or paliperidone.
... Symptom severity, cognitive functioning and neurological status were assessed in the patient group using the Positive and Negative Syndrome Scale (PANSS) 20 , the Brief Psychiatric Rating Scale (BPRS) 21 , the Brief Negative Symptom Scale (BNSS) 22 , the Trail Making Test (TMT B-A) 23 , and the Neurological Evaluation Scale (NES) 24 . To measure real-world functioning, patients also completed the Specific Levels of Functioning Scale (SLOF) 25 . ...
Aberrant motor-sensory predictive functions have been linked to symptoms of psychosis, particularly reduced attenuation of self-generated sensations and misattribution of self-generated actions. Building on the parallels between prediction of self- and other-generated actions, this study aims to investigate whether individuals with psychosis also demonstrate abnormal perceptions and predictions of others’ actions. Patients with psychosis and matched controls completed a two-alternative object size discrimination task. In each trial, they observed reaching actions towards a small and a large object, with varying levels of temporal occlusion ranging from 10% to 80% of movement duration. Their task was to predict the size of the object that would be grasped. We employed a novel analytic approach to examine how object size information was encoded and read out across progressive levels of occlusion with single-trial resolution. Patients with psychosis exhibited an overall pattern of reduced and discontinuous evidence integration relative to controls, characterized by a period of null integration up to 20% of movement duration, during which they did not read any size information. Surprisingly, this drop in accuracy in the initial integration period was not accompanied by a reduction in confidence. Difficulties in action prediction were correlated with the severity of negative symptoms and impaired functioning in social relationships.
... Evidence-based assessment tools should capture the complexity of functional outcomes, which can thereby promote a better understanding of the interplay between illness-related variables, personal resources, and context-related factors (Galderisi & Rucci, 2018;Morin & Franck, 2017). Studies have proposed multiple function domains in the real world, including vocational performance, social function, and everyday activities (Leifker et al., 2011;Schneider & Struening, 1983). Enhancing the assessment of functional outcomes and contextrelated factors would improve our understanding of the difficulty that people with chronic psychosis face (Rocca et al., 2021). ...
Objective:
Occupational function assessment is essential for rehabilitation of severe mental illness but lacks comprehensive tools.
Method:
This study examines the psychometric properties of the Chinese versions of the Vocational Cognitive Rating Scale (VCRS) and the Work Behavior Inventory (WBI) in 60 chronic patients from a psychiatric daycare center and identifies clinical correlates of occupational function measured on the Positive and Negative Syndrome Scale (PANSS).
Results:
The Chinese VCRS and WBI showed adequate internal consistency, interrater and test-retest reliability, and good convergent validity with the Comprehensive Occupational Therapy Evaluation Scale. Factor analysis favored a one-factor solution of the VCRS; and a four-factor structure in the WBI including Efficiency, Social Interaction, Appropriateness, and Regularity. The VCRS and Efficiency were predicted by fewer disorganization but greater affective symptoms. Social Interaction was negatively predicted by resistance symptoms. Appropriateness was associated with all but negative symptoms. Regularity was predicted by fewer negative symptoms. Considering work behavior altogether, WBI total scores were predicted by fewer negative, fewer disorganization, and greater affective symptoms.
Conclusions and implication for practice:
Findings suggest that the Chinese VCRS and WBI have sound psychometric properties and are suitable for both clinical trials and for planning personalized rehabilitation programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
... Continue Treatment. The following factors, which have been associated with the clinicians' transition recommendation in a previous study within this cohort [24] were included clinician-rated severity of psychopathology (Clinical Global Impression-Severity scale (CGI-S; [30])), psychotic experiences (Development and Well-Being Assessment (DAWBA; [31])), everyday functional skills (Specific Levels of Functioning (SLOF; [32])), psychotropic medication use (Service Receipt Inventory EU version (CSSRI-EU; [33])), length of CAMHS use (sociodemographic interview), the availability of appropriate AMHS according to the clinician (TRAM) and self-and parent-reported need for continued treatment (TRAM). ...
Background. Clinicians in Child and Adolescent Mental Healthcare Services (CAMHS) face the challenge to determine who is at risk of persistence of depressive problems into adulthood and requires continued treatment after reaching the CAMHS upper age limit of care-provision. We assessed whether risk factors for persistence were related to CAMHS clinicians’ transition recommendations. Methods. Within the wider MILESTONE cohort study, 203 CAMHS users were classified with unipolar depressive disorder by their clinician, and 185 reported clinical levels of depressive problems on the DSM-oriented Depressive Problems scale of the Achenbach Youth Self Report. Logistic regression models were fitted to both subsamples to assess the relationship between clinicians’ transition recommendations and risk factors for persistent depression. Results. Only clinician-rated severity of psychopathology was related to a recommendation to continue treatment for those classified with unipolar depressive disorder ( N = 203 ; OR = 1.45 , 95% CI (1.03–2.03), p = .044 ) and for those with self-reported depressive problems on the Achenbach DSM-oriented Depressive Problems scale ( N = 185 ; OR = 1.62 , 95% CI (1.12–2.34), p = .012 ). Conclusion. Transition recommendations and need for continued treatment are based on clinical expertise, rather than self-reported problems and needs.
... Real-world functioning was assessed by the Specific Level of Functioning Scale (SLOF), an informant-rated measure that explores many aspects of functioning and is based on the key caregiver's judgment on behavior and functioning of patients [64]. It consists of 43 items, divided into six different scales, and includes the following domains: physical efficiency, skills in selfcare, interpersonal relationships, social acceptability, participation in community activities (e.g., shopping, using public transportation), and working abilities. ...
Background: Autistic symptoms represent a frequent feature in people with schizophrenia spectrum disorders (SSD), with a significant impact on clinical, cognitive and functional outcomes. However, the prevalence and the cognitive and functional correlates of autistic symptoms in unaffected first-degree relatives of people with SSD remain to be assessed.
Methods: A total of 342 unaffected first-degree relatives related to 247 outpatients diagnosed with schizophrenia were recruited as part of the multicenter study of the Italian Network for Research on Psychoses (NIRP). Autistic features were measured with the PANSS Autism Severity Scale (PAUSS). Three groups of participants defined on presence and severity of autistic symptoms were compared on a wide array of cognitive and functional measures.
Results: Of the total sample, 44.9% presented autistic symptoms; 22.8% showed moderate levels of autistic symptoms, which can be observed in the majority of people diagnosed with SSD. Participants with higher levels of autistic symptoms showed worse performance on Working Memory (p=0.014) and Social Cognition (p=0.025) domains and in the Global Cognition composite score (p=0.008), as well as worse functional capacity (p=0.001), global psychosocial functioning (p<0.001), real-world interpersonal relationships (p<0.001), participation in community activities (p=0.017) and work skills (p=0.006).
Conclusions: A high prevalence of autistic symptoms was observed in first-degree relatives of people with SSD. Autistic symptoms severity showed a negative correlation with cognitive performance and functional outcomes also in this population and may represent a diagnostic and treatment target of considerable scientific and clinical interest in both patients and their first-degree relatives.
... More overestimation of performance in the WCST was associated with poorer global judgement of performance. (Stroop, 1935), SLOF ¼ Specific Levels of Functioning (Schneider and Struening, 1983), SSP ¼ Spatial Span Test, TMT-A ¼ Trail Making Test -Part A (Gaudino et al., 1995), TMT-B ¼ Trail Making Test -Part B (Gaudino et al., 1995), UPSA-B Performance-based Skills Assessment (Mausbach et al., 2007), WAIS-R ¼ Wechsler Adult Intelligence Scale-Revised (Wechsler, 1955), WCST ¼ Wisconsin Card Sorting Test (Koren et al., 2004), WMS-III ¼ Wechsler Memory Scale -3rd edition. ...
... Real-world functional outcomes were assessed with the informant-rated version of the Specific Level of Functioning Scale (SLOF) (Schneider & Struening, 1983). The interpersonal relationships, social acceptability, participation in daily activities and work skills subscales were included in the assessment battery. ...
Background:
Life engagement represents a holistic concept that encompasses outcomes reflecting life-fulfilment, well-being and participation in valued and meaningful activities, which is recently gaining attention and scientific interest. Despite its conceptual importance and its relevance, life engagement represents a largely unexplored domain in schizophrenia. The aims of the present study were to independently assess correlates and predictors of patient life engagement in a large and well-characterized sample of schizophrenia patients.
Methods:
To assess the impact of different demographic, clinical, cognitive and functional parameters on life engagement in a large sample of patients with schizophrenia, data from the social cognition psychometric evaluation project were analyzed.
Results:
Overall schizophrenia and depressive symptom severity, premorbid IQ, neurocognitive performance, social cognition performance both in the emotion processing and theory of mind domains, functional capacity, social skills performance and real-world functioning in different areas all emerged as correlates of patient life engagement. Greater symptom severity and greater impairment in real-world interpersonal relationships, social skills, functional capacity and work outcomes emerged as individual predictors of greater limitations in life engagement.
Conclusions:
Life engagement in people living with schizophrenia represents a holistic and complex construct, with several different clinical, cognitive and functional correlates. These features represent potential treatment targets to improve the clinical condition and also facilitate the process of recovery and the overall well-being of people living with schizophrenia.
... Functional Recovery. The work skills and interpersonal relationships subscales of the Specific Level of Functioning Scale were used to measure functional recovery (Schneider & Struening, 1983). This measure contained 13 items. ...
The present study investigated how perceived stigma from mental health service providers would influence the mental health recovery of people with mental illness. Specifically, this study examined whether perceived stigma from service providers would adversely affect the clinical, functional, and personal recovery of people with mental illness by exacerbating the content and process of self-stigma and service disengagement. A total of 353 people with mental illness completed questionnaires about perceived stigma from service providers, self-stigma content and process, service disengagement, and clinical, functional, and personal recovery. The associations among these variables were analyzed using structural equation modeling and bootstrap analyses. Structural equation modeling showed that perceived stigma from service providers was related to higher levels of self-stigma content and process, which were, in turn, related to greater levels of service disengagement and then lower levels of clinical, functional, and personal recovery. Bootstrap analyses further showed that perceived stigma from service providers had significant indirect effects on clinical, functional, and personal recovery through self-stigma content and process and service disengagement. Our findings show that perceived stigma from service providers may adversely affect mental health recovery through intensifying self-stigma and heightening service disengagement. These findings highlight the importance of mitigating the stigma-related experiences of people with mental illness in order to facilitate their mental health recovery.
Research and clinical work demonstrate that adults with intellectual and developmental disabilities (IDDs; including autistic adults and adults with other IDDs) struggle with key outcomes in adult life, including social relationships, employment, autonomy, and life satisfaction. However, few validated measures exist to measure these outcomes in adults with IDDs. The Relationships, Employment, Autonomy, and Life Satisfaction (REALS) Measures were created using methods developed by the Patient‐Reported Outcomes Measurement Information System (PROMIS) to assess these outcomes. Large item pools were generated for the four domains, and, in field testing, 875 adults with IDDs (90% autistic; 18.4% with intellectual disability or a non‐autism IDD) and 911 proxy reporters (caregivers; 79% autistic; 48.3% with intellectual disability or a non‐autism IDD) completed 108 and 74 items, respectively, using response options capturing frequency, level of support needed, and satisfaction. The structure and item content of the REALS Measures were determined through an iterative process using both classical test theory and item response theory analyses. The final versions include 19 self‐report and 14 proxy‐report measures, with a range of 3 to 14 items each. The measures have excellent psychometric properties, high precision, and acceptable respondent burden. Thus, they are applicable for service provision, clinical, and research arenas for autistic adults and adults with other IDDs, though additional testing in IDD is warranted and evidence supporting self‐report use in IDD is more limited.
Background and Hypotheses
People with schizophrenia are at risk for social exclusion, yet we know little about their responses. We hypothesized (1) people with schizophrenia would be more likely to withdraw following social exclusion compared to controls; (2) withdrawal intentions would be greater following exclusion compared to disappointment; (3) withdrawal behavior would be predicted by rejection sensitivity, alternative sources of acceptance, chronicity of exclusion, and perceived fairness; and (4) withdrawal following exclusion would be associated with more negative symptoms and poorer functioning.
Study Design
People with (n = 43) and without (n = 43) schizophrenia or schizoaffective disorder played Cyberball - Behavioral Response, a novel version of the exclusion task. Participants responded to social exclusion with affiliative, retaliatory, and withdrawal behaviors within a 2 (Group: Schizophrenia vs. Control) × 3 (Game Type: Exclusion vs. Disappointment vs. Inclusion) mixed design. Participants reported their social experiences, affective and psychological responses following exclusion, negative symptoms, and functioning.
Study Results
People with schizophrenia reported heightened rejection sensitivity, fewer alternative sources of acceptance, and more chronic exclusion in daily life compared to controls. They responded to exclusion with more withdrawal behavior than controls, with social exclusion eliciting more of these responses than disappointment. Withdrawal responses were associated with chronicity of exclusion, and withdrawal and exclusion in daily life were linked to functional outcomes.
Conclusions
People with schizophrenia experience frequent social exclusion in daily life, and this predicts withdrawal responses to social exclusion. Findings provide initial evidence of vulnerability to a cycle of exclusion and withdrawal.
Background and Hypothesis
Among individuals living with psychotic disorders, social impairment is common, debilitating, and challenging to treat. While the roots of this impairment are undoubtedly complex, converging lines of evidence suggest that social motivation and pleasure (MAP) deficits play a central role. Yet most neuroimaging studies have focused on monetary rewards, precluding decisive inferences.
Study Design
Here we leveraged parallel social and monetary incentive delay functional magnetic resonance imaging paradigms to test whether blunted reactivity to social incentives in the ventral striatum—a key component of the distributed neural circuit mediating appetitive motivation and hedonic pleasure—is associated with more severe MAP symptoms in a transdiagnostic adult sample enriched for psychosis. To maximize ecological validity and translational relevance, we capitalized on naturalistic audiovisual clips of an established social partner expressing positive feedback.
Study Results
Although both paradigms robustly engaged the ventral striatum, only reactivity to social incentives was associated with clinician-rated MAP deficits. This association remained significant when controlling for other symptoms, binary diagnostic status, or striatal reactivity to monetary incentives. Follow-up analyses suggested that this association predominantly reflects diminished activation during the presentation of social reward.
Conclusions
These observations provide a neurobiologically grounded framework for conceptualizing the social-anhedonia symptoms and social impairments that characterize many individuals living with psychotic disorders and underscore the need to develop targeted intervention strategies.
In psychotic disorders, motivation and pleasure (MAP) deficits are associated with decreased affiliation and heightened functional impairment. We leveraged a transdiagnostic sample enriched for psychosis and a multimethod approach to test the hypothesis that MAP deficits undermine the stress-buffering benefits of affiliation. Participants completed the social-affiliation-enhancement task (SAET) to cultivate affiliation with an experimental partner. Although the SAET increased perceived affiliation and mood, individuals with greater negative symptoms derived smaller emotional benefits from the partners, as indexed by self-report and facial behavior. We then used the handholding functional MRI paradigm, which combines threat anticipation with affiliative physical contact, to determine whether MAP deficits undermine the social regulation of distress. Individuals with greater MAP deficits showed diminished neural “benefits”—reduced dampening of threat-elicited activation—from affiliative touch in key frontoparietal nodes of the dorsal attention network. In short, MAP symptoms disrupt the emotional and neuroregulatory benefits of affiliation.
Background:
People with schizophrenia often experience long-term psychosocial disabilities and frequent relapse. Family plays a key role in caring for ill relatives, which in turn probably contributes to high levels of distress and burdens for the family. Family-based interventions have been developed and applied to family members and their relatives with schizophrenia to improve their outcomes. This is an update of a Cochrane review that was last updated in 2011, which has been split into this review, one on group- versus individual-based family interventions and one on family-based cognitive versus behavioural management interventions.
Objectives:
To assess the effects of family-based interventions for people with schizophrenia or schizophrenia-like disorders and their families compared with standard care.
Search methods:
We searched the following electronic databases from inception until April 2023: CENTRAL, Medline, Embase, PsycInfo, CINAHL, WHO International Clinical Trials Registry Platform (ICTRP), Clinicaltrials.gov, SinoMed, China Network Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific Journals Database (VIP). We also searched the reference lists of included studies and accessible reviews for additional references.
Selection criteria:
We included randomised controlled trials (RCTs) that compared the effects of family-based interventions for people with schizophrenia or schizophrenia-like disorders and their families and reported at least one patient's and one family member's outcomes. In this update, we only investigated standard care as the comparator.
Data collection and analysis:
We used standard Cochrane methods. The review authors independently screened studies, extracted data, and assessed risk of bias for each study using the Cochrane risk of bias tool for RCTs. We pooled data and estimated effects with the mean difference (MD), standardised mean difference (SMD), or risk ratio (RR) with 95% confidence interval (CI). We judged the certainty of evidence using GRADEpro GDT. We divided the outcomes into short-term (≤ 1 month postintervention), medium-term (> 1 to 6 months postintervention), and long-term follow-up (> 6 months postintervention), if available.
Main results:
We identified 26 RCTs in this review, with 1985 people with schizophrenia or schizophrenia-like disorders, and 2056 family members. Most family-based interventions were conducted on a weekly or biweekly basis, with duration ranging from five weeks to two years. We had substantial concerns regarding the methodological quality of the included studies given that we judged all studies at high risk of performance bias and several studies at high risk of detection, attrition or reporting bias. Low-certainty evidence indicated that family-based interventions may reduce patients' relapse at one month or less postintervention (RR 0.66, 95% CI 0.49 to 0.89; 4 RCTs, 229 participants). We downgraded the evidence by two levels due to imprecision (small number of participants) and high risk of performance, detection and attrition bias. Compared to standard care, family-based interventions probably reduce caregiver burden at one month or less postintervention (MD -5.84, 95% CI -6.77 to -4.92; 8 RCTs, 563 participants; moderate-certainty evidence) and may result in more family members shifting from high to low expressed emotion (RR 3.90, 95% CI 1.11 to 13.71; 2 RCTs, 72 participants; low-certainty evidence). Family interventions may result in little to no difference in patients' death (RR 0.48, 95% CI 0.18 to 1.32; 6 RCTs, 304 participants; low-certainty evidence) and hospital admission (≤ 1 month postintervention; RR 0.81, 95% CI 0.51 to 1.29; 2 RCTs, 153 participants; low-certainty evidence) in comparison with standard care. Due to the heterogeneous measures and various follow-up periods, we were unable to provide pooled effect estimates for patients' compliance with medication and quality of life. We were very uncertain whether family interventions resulted in enhanced compliance with medication and improved quality of life for patients. We downgraded the evidence to very low certainty due to high risk of bias across studies, inconsistency (different directions of effects across studies), and imprecision (small number of participants or CIs of most studies including the possibility of no effect).
Authors' conclusions:
This review synthesised the latest evidence on family interventions versus standard care for people with schizophrenia or schizophrenia-like disorders and their families. This review suggests that family interventions might improve patients' outcomes (e.g. relapse) and families' outcomes (e.g. caregiver burden and expressed emotion), with little to no difference in patients' hospital admission and adverse effects in terms of death. However, evidence on patients' compliance with medication and quality of life was very uncertain. Overall, the evidence was of moderate to very low certainty. Future large and well-designed RCTs are needed to provide more reliable evaluation of effects of family interventions in people with schizophrenia or schizophrenia-like disorders and their families.
Background
The burden of schizophrenia is largely due to deficits it causes in functioning. However, the variables influencing and predicting real-life functioning have not been systematically investigated in such patients.
Aims
The aims of this study were to study the sociodemographic data, illness-related variables, and level of functioning in patients with schizophrenia and to assess the relationship between clinical correlates, symptomatology, and level of functioning.
Materials and Methods
This was a cross-sectional study conducted in the psychiatry outpatient department of a teaching hospital. Sociodemographic and illness-related data were collected using a semi-structured pro forma. Schizophrenia was diagnosed as per the International Classification of Diseases-10 criteria, and severity of symptoms was rated using Positive and Negative Syndrome Scale (PANSS). Functional outcomes were rated using the Social and Occupational Functioning Assessment Scale (SOFAS) and Specific Level of Functioning (SLOF) scale. The data were compiled, tabulated, and analyzed.
Results
A total of 170 patients suffering from schizophrenia with a mean age of 38.22 years were recruited for the study. On the SOFAS, 56.5% of patients scored more than 60, indicating good functionality. It was found that age at onset had a positive correlation, whereas duration of illness, duration of untreated psychosis (DUP), positive family history of psychosis, and PANSS scores had a negative correlation with SOFAS and SLOF subdomain scores.
Conclusion
In patients with schizophrenia, male gender, unemployment, positive family history of psychosis, lower age at onset, longer duration of illness, longer DUP, and greater symptom severity (positive and negative) are associated with poor functioning.
People with serious mental illness (SMI) encounter restrictions in the quantity of their community participation. Less is known about the quality of their participation. We aimed to explore the relationship between symptoms of SMI and the daily experience (i.e., loneliness and enjoyment) of community participation. We examined daily community participation among people with SMI using ecological momentary assessment surveys. We built multilevel models to examine the associations between symptoms of SMI and loneliness or enjoyment during community participation. Our analysis included 183 people among four participant groups: bipolar disorder ( n = 44), major depressive disorder ( n = 46), schizophrenia/schizoaffective disorder ( n = 40), and control ( n = 53). People with schizophrenia engaged in more unstructured activities (e.g., socializing) than people among other groups. Symptom association varied across diagnostic groups. To support tailored intervention development, researchers and practitioners should consider the context of participation and the clinical characteristics of the client.
Introduction:
In schizophrenia, social functioning and personal recovery are pivotal outcomes potentially influenced by cognitive biases such as Jumping to Conclusions (JTC). Despite their significance, the relationship between JTC, social functioning, and personal recovery remains unclear. This study aims to investigate this relationship to inform tailored interventions for schizophrenia management.
Methods:
Data were collected from 94 schizophrenia patients using standardised measures. The Beads Task assessed JTC, whereas the Brief PANSS, TMT-J, SLOF-J, and RAS-J evaluated psychiatric symptoms, neurocognitive functioning, social functioning, and personal recovery, respectively. Statistical analyses included correlation and hierarchical regression.
Results:
Correlation analyses revealed a significant negative correlation between JTC and personal recovery (r = -0.27, p < 0.05). Hierarchical regression indicated JTC as a significant negative predictor of personal recovery (β = -0.33, p = 0.01). No significant correlation was found between JTC and social functioning.
Discussion:
Increased JTC was associated with lower levels of personal recovery in schizophrenia patients, independent of demographic and clinical factors. In the case of individuals with schizophrenia who demonstrate JTC, there is a potential to suggest the paradox of insight or apparent personal recovery scores.
Background and Hypothesis
Loneliness, the subjective experience of feeling alone, is associated with physical and psychological impairments. While there is an extensive literature linking loneliness to psychopathology, limited work has examined loneliness in daily life in those with serious mental illness. We hypothesized that trait and momentary loneliness would be transdiagnostic and relate to symptoms and measures of daily functioning.
Study Design
The current study utilized ecological momentary assessment and passive sensing to examine loneliness in those with schizophrenia (N = 59), bipolar disorder (N = 61), unipolar depression (N = 60), remitted unipolar depression (N = 51), and nonclinical comparisons (N = 82) to examine relationships of both trait and momentary loneliness to symptoms and social functioning in daily life.
Study Results
Findings suggest that both trait and momentary loneliness are higher in those with psychopathology (F(4,284) = 28.00, P < .001, ηp2 = 0.27), and that loneliness significantly relates to social functioning beyond negative symptoms and depression (β = −0.44, t = 6.40, P < .001). Furthermore, passive sensing measures showed that greater movement (β = −0.56, t = −3.29, P = .02) and phone calls (β = −0.22, t = 12.79, P = .04), but not text messaging, were specifically related to decreased loneliness in daily life. Individuals higher in trait loneliness show stronger relationships between momentary loneliness and social context and emotions in everyday life.
Conclusions
These findings provide further evidence pointing to the importance of loneliness transdiagnostically and its strong relation to social functioning. Furthermore, we show that passive sensing technology can be used to measure behaviors related to loneliness in daily life that may point to potential treatment implications or early detection markers of loneliness.
Background
Cognitive impairment, a core feature of schizophrenia, is associated with poor outcomes. Pharmacotherapy and psychosocial treatment, when used alone, have inadequate effect sizes for cognitive impairment, leading to recent interest in combination interventions. A previous study examined the additive effect of cognitive remediation on lurasidone in patients with schizophrenia, which was negative. Although improvement in cognitive function was suggested for lurasidone, it was inconclusive because there was no antipsychotic control in the study. To clarify whether lurasidone has a meaningful impact on cognitive function in combination with cognitive remediation, we use paliperidone as a control antipsychotic in this study. We hypothesize that combination with lurasidone will improve cognitive and social function to a greater extent than paliperidone.
Methods
The valuable interaction with cognitive remediation and optimal antipsychotics for recovery in schizophrenia study is a multicenter, interventional, open-label, rater-blind, randomized comparison study, comparing the effect of lurasidone plus cognitive remediation with that of paliperidone plus cognitive remediation in patients with schizophrenia. The Neuropsychological Educational Approach to Remediation (NEAR) is used for cognitive remediation. Eligible patients will be randomized 1:1 to receive lurasidone or paliperidone combined with NEAR (6 weeks antipsychotic alone followed by 24 weeks combination antipsychotic plus NEAR). The primary endpoint is the change from baseline in the tablet-based Brief Assessment of Cognition in Schizophrenia composite T-score at the end of the NEAR combination treatment period. Secondary endpoints will include change from baseline in social function, schizophrenia symptoms, and quality of life at the end of the NEAR combination treatment period. Furthermore, change from baseline to the end of the pharmacotherapy period and change from the end of the pharmacotherapy period to the end of the NEAR combination treatment period will be assessed for all endpoints. Safety will also be evaluated.
Discussion
Achievement of adequate cognitive function is central to supporting social function, which is a key treatment goal for patients with schizophrenia. We think this study will fill in the gaps of the previous study and provide useful information regarding treatment decisions for patients with schizophrenia.
Clinical trial registration
Japan Registry of Clinical Trials ID, jRCTs031200338.
Introduction
Alterations of verbalized thought occur frequently in psychotic disorders. We characterize linguistic findings in individuals with schizophrenia based on the current literature, including findings relevant for differential and early diagnosis.
Methods
Review of literature published via PubMed search between January 2010 and May 2022.
Results
A total of 143 articles were included. In persons with schizophrenia, language-related alterations can occur at all linguistic levels. Differentiating from findings in persons with affective disorders, typical symptoms in those with schizophrenia mainly include so-called “poverty of speech,” reduced word and sentence production, impaired processing of complex syntax, pragmatic language deficits as well as reduced semantic verbal fluency. At the at-risk state, “poverty of content,” pragmatic difficulties and reduced verbal fluency could be of predictive value.
Discussion
The current results support multilevel alterations of the language system in persons with schizophrenia. Creative expressions of psychotic experiences are frequently found but are not in the focus of this review. Clinical examinations of linguistic alterations can support differential diagnostics and early detection. Computational methods (Natural Language Processing) may improve the precision of corresponding diagnostics. The relations between language-related and other symptoms can improve diagnostics.
Introduction:
The study explored associations between the accuracy of post assessment judgements of cognitive performance with global self-assessments of psychosocial functioning compared to evaluations generated by observers in schizophrenia and bipolar disorder.
Methods:
An abbreviated cognitive assessment based on the MATRICS Consensus Cognitive Battery was administered to 122 individuals with schizophrenia and 113 with bipolar disorder. They provided self-estimates of their performance after each subtest. In addition, self-reports on cognition, social cognition, and everyday functioning were collected and compared to observer ratings.
Results:
Both groups overestimated their cognitive function, but in bipolar disorder, there was 30% shared variance between task performance and self-rated task performance (vs. 5% in schizophrenia). Significant correlations were found between self-reported everyday outcomes and both actual and self-assessed performance. In schizophrenia, immediate judgements were only related to self-rated functioning, not to observer rated functioning. In bipolar disorder, impairments in self-assessment of performance correlated with observer ratings of cognitive ability, which was not observed in schizophrenia.
Conclusions:
While both groups showed correlations between cognitive performance and introspective accuracy, individuals with bipolar disorder showed higher accuracy in assessing their cognitive performance and other outcomes. Notably, impairments in introspective accuracy were associated with observer-rated functioning exclusively in bipolar disorder.
The relationship between mood and productivity has been a topic of interest for researchers and individuals seeking to improve their work output. Numerous studies have shown that mood can have a significant impact on productivity. Positive moods have been found to increase productivity, while negative moods can decrease productivity. Research suggests that positive moods, such as happiness and contentment, can lead to higher levels of productivity by increasing motivation, creativity, and focus. Positive moods have also been linked to higher levels of job satisfaction and better overall performance. On the other hand, negative moods, such as anxiety and stress, can decrease productivity by causing distractions, impairing decision-making ability, and reducing energy levels. Our study seeks to determine the effect of mood on productivity by applying statistical tools on collected data and testing the hypothesis. In our study it is found that employees who experienced positive moods were able to complete tasks faster and with fewer errors than those in a negative mood. Overall, the evidence suggests that mood plays a crucial role in productivity. By recognizing the impact of mood on productivity, individuals can take steps to cultivate positive moods and manage negative ones, leading to better outcomes both in the workplace and in other areas of life.
For individuals living with serious mental illnesses (SMIs), inadequate meal preparation skills can hinder the ability to live independently; yet rating scales tailored for this population are lacking. We describe development, item analysis, and initial reliability and validity of the Staff-Administered Meal Independence Rating Scale (SAMIRS). After item development involving expert consultation, two rounds of pilot testing ( n = 188, n = 293) were conducted in inpatient and residential settings (transitional living residences [TLRs] and community residences [CRs]). For initial testing of convergent validity, Pearson correlations with Specific Levels of Functioning (SLOF) scale items were computed. Exploratory factor analysis revealed a single factor; Cronbach's alpha was high (0.98). The mean SAMIRS score varied by setting: CR residents scored higher than those in TLRs or inpatient units. Scores were highly correlated with SLOF items measuring community living skills. Although further study is warranted, the SAMIRS could be a useful tool in rating functional needs pertaining to meal independence among individuals with SMI.
Background and hypothesis:
Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships.
Study design:
Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA).
Results:
Two components, working memory/processing speed/episodic memory (βs = 0.18-0.42), and negative/positive reinforcement learning (β = -0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function.
Conclusions:
These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.
Introduction
Gesture performance deficits are prevalent in schizophrenia patients and are strongly associated with poor social communication skills and community functioning, affecting their overall quality of life. Currently, video-recording technology is widely used in clinical settings to assess gesture production deficits in schizophrenia patients. Nevertheless, the subjective evaluation of video-recordings can encumber task assessment. The present study will aim to use virtual reality to examine its potential use as an alternative tool to objectively measure gesture performance accuracy in schizophrenia patients and healthy controls.
Methods
Gesture performance in the virtual reality setting will be based on the well-established Test of Upper Limb Apraxia. Participants will be immersed in a virtual environment where they will experience themselves being embodied in a collocated virtual body seen from a first-person perspective. Motion trackers will be placed on participants' hands and elbows to track upper body movements in real-time, and to record gesture movement for later analysis. Participants will see a virtual agent sitting across from them, with a virtual table in between. The agent will perform various types of gestures and the participants' task will be to imitate those gestures as accurately as possible. Measurements from the tracking devices will be stored and analyzed to address gesture performance accuracy across groups.
Discussion
This study aims to provide objective measurements of gesture performance accuracy in schizophrenia patients. If successful, the results will provide new knowledge to the gesture literature and offer the potential for novel therapeutic interventions using virtual reality technologies. Such interventions can improve gesturing and thus advance social communication skills in schizophrenia patients.
Background: Impaired social functioning is a major, but
under-elucidated area of schizophrenia. It’s typically understood
as consequential to, eg, negative symptoms, but
meta-analyses on the subject have not examined psychopathology
in a broader perspective and there’s severe heterogeneity
in outcome measures. To enhance functional
recovery from schizophrenia, a more comprehensive understanding
of the nature of social functioning in schizophrenia
is needed. Study Design: In this systematic review
and meta-analysis, we searched PubMed, PsycInfo, and
Ovid Embase for studies providing an association between
psychopathology and social functioning. Meta-analyses
of the regression and correlation coefficients were performed
to explore associations between social functioning
and psychopathology, as well as associations between their
subdomains. Study Results: Thirty-six studies with a
total of 4742 patients were included. Overall social functioning
was associated with overall psychopathology (95%
CI [−0.63; −0.37]), positive symptoms (95% CI [−0.39;
−0.25]), negative symptoms (95% CI [−0.61; -0.42]), disorganized
symptoms (95% CI [−0.54; −0.14]), depressive
symptoms (95% CI [−0.33; −0.11]), and general psychopathology
(95% CI [−0.60; −0.43]). There was significant
heterogeneity in the results, with I2 ranging from 52% to
92%. Conclusions: This is the first systematic review and
meta-analysis to comprehensively examine associations between
psychopathology and social functioning. The finding
that all psychopathological subdomains seem to correlate
with social functioning challenges the view that impaired
social functioning in schizophrenia is mainly a result of
negative symptoms. In line with classical psychopathological
literature on schizophrenia, it may be more appropriate
to consider impaired social functioning as a manifestation
of the disorder itself.
Patients with the 22q11.2 deletion syndrome (DS) show an increased risk of developing a psychotic illness lifetime. 22q11.2DS may represent a reliable model for studying the neurobiological underpinnings of schizophrenia. The study of social inference abilities in a genetic condition at high risk for psychosis, like 22q11.2DS, may shed light on the relationships between neurocognitive processes and patients' daily general functioning. The study sample consisted of 1736 participants, divided into four groups: 22q11.2DS patients with diagnosis of psychotic disorder (DEL SCZ, N = 20); 22q11.2DS subjects with no diagnosis of psychosis (DEL, N = 43); patients diagnosed with schizophrenia without 22q11.2DS (SCZ, N = 893); and healthy controls (HC, N = 780). Social cognition was assessed through The Awareness of Social Inference Test (TASIT) and general functioning through the Specific Levels of Functioning (SLoF) scale. We analysed data through regression analysis. The SCZ and DEL groups had similar levels of global functioning; they both had significantly lower SLoF Total scores than HC (p < .001); the DEL SCZ group showed significantly lower scores compared to the other groups (SCZ, p = .004; DEL, p = .003; HC, p < .001). A significant deficit in social cognition was observed in the three clinical groups. In the DEL SCZ and SCZ groups, TASIT scores significantly predicted global functioning (p < .05). Our findings of social cognition deficit in psychosis-prone patients point to the possible future adoption of rehabilitation programmes, like Social Skills Training and Cognitive Remediation, during premorbid stages of psychosis.
Sleep and rest-activity-rhythm (RAR) abnormalities are commonly reported in schizophrenia spectrum disorder (SSD) patients. However, an in-depth characterization of sleep/RAR alterations in SSD, including patients in different treatment settings, and the relationship between these alterations and SSD clinical features (e.g., negative symptoms) is lacking. SSD (N = 137 altogether, N = 79 residential and N = 58 outpatients) and healthy control (HC) subjects (N = 113) were recruited for the DiAPAson project. Participants wore an ActiGraph for seven consecutive days to monitor habitual sleep-RAR patterns. Sleep/rest duration, activity (i.e., M10, calculated on the 10 most active hours), rhythm fragmentation within days (i.e., intra-daily variability, IV; beta, steepness of rest-active changes), and rhythm regularity across days (i.e., inter-daily stability, IS) were computed in each study participant. Negative symptoms were assessed in SSD patients with the Brief Negative Symptom Scale (BNSS). Both SSD groups showed lower M10 and longer sleep/rest duration vs. HC, while only residential patients had more fragmented and irregular rhythms than HC. Compared to outpatients, residential patients had lower M10 and higher beta, IV and IS. Furthermore, residential patients had worse BNSS scores relative to outpatients, and higher IS contributed to between-group differences in BNSS score severity. Altogether, residentials and outpatients SSD had both shared and unique abnormalities in Sleep/RAR measures vs. HC and relative to one another, which also contributed to the patients’ negative symptom severity. Future work will help establish whether improving some of these measures may ameliorate the quality of life and clinical symptoms of SSD patients.
ResearchGate has not been able to resolve any references for this publication.