Neurocognition, Social Cognition, Perceived Social Discomfort, and Vocational Outcomes in Schizophrenia

Department of Psychiatry, School of Medicine, Yale University, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 02/2008; 35(4):738-47. DOI: 10.1093/schbul/sbm169
Source: PubMed


Social cognition has been suggested to be an important mediating variable in the relationship between neurocognition and functional outcome. The present study tested this model in relation to work rehabilitation outcome and added self-reported social discomfort as a possible mediator. One hundred fifty-one participants with schizophrenia or schizoaffective disorder participated in a 26-week work therapy program. Neurocognition was constructed as a latent construct comprised of selected variables from our intake test battery representing executive functioning, verbal memory, attention and working memory, processing speed, and thought disorder. Social cognition at intake was the other latent construct comprised of variables representing affect recognition, theory of mind, self-reported egocentricity, and ratings of rapport. The 2 latent constructs received support from confirmatory factor analysis. Social discomfort on the job was based on their self-report on a weekly questionnaire. In addition, we constructed a composite rehabilitation outcome that was based on how many hours they worked, how well they worked, and how complex was the job that they were doing. Path analysis showed direct effects of neurocognition on rehabilitation outcome and indirect effects mediated by social cognition and social discomfort. This model proved to be a good fit to the data and far superior to another model where only social cognition was the mediating variable between neurocognition and rehabilitation outcome. Findings suggest that neurocognition affects social cognition and that poorer social cognition leads to social discomfort on the job, which in turn leads to poorer rehabilitation outcomes. Implications for rehabilitation interventions are discussed.

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Available from: Morris D Bell, Jul 22, 2014
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    • "Emerging evidence from such studies suggests that these predictors have both direct (independent), as well as, indirect (meditational ) effects on functional outcome through cascading paths. For example, the influence of NC on functional outcome is either direct (Lipkovich et al., 2009; Bell et al., 2009) or indirect, mediated by SC (Schmidt et al., 2012; Hoe et al., 2012), meta-cognition (Lysaker et al., 2010), motivation (Nakagami et al., 2008) and Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: Understanding the complex relationship among determinants of real-world functioning in schizophrenia patients in remission is important in planning recovery-oriented interventions. We explored two path-analytical models of functioning in schizophrenia. 170 Schizophrenia patients remitted from positive symptoms underwent fairly comprehensive assessments of cognition - neurocognition (NC) and social cognition (SC), residual symptoms - insight, motivation and other negative symptoms, and socio-occupational functioning. We explored (a) a cascading model, where NC predicted functional outcome through its effects on other determinants and (b) a combined model, incorporating additional direct paths from each of the determinants. The combined model, and not the cascading model demonstrated a good fit. Post-hoc trimming of the combined model by elimination of non-significant paths maintained the goodness-of-fit and was retained as the final model. In addition to the direct paths, this final model demonstrated that (a) NC influenced functioning through SC and insight and (b) SC influenced functioning through motivation and negative symptoms. This suggests that NC and SC may influence functional outcome directly, as well as indirectly, via specific impact on insight, and motivation and negative symptoms respectively. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Jul 2015
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    • "These constructs, social and non-social cognition, although share a common base and are partially correlated (cf. Couture, Penn & Roberts, 2006, Bell et al., 2009, Hoe et al., 2012), are yet distinct, and their influence could manifest in a different way (Fett et al., 2011). Thus, we sought to capture the relationship between the two types of cognition and functioning, assuming that social cognition would have a higher correlation with outcomes. "
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    Full-text · Article · May 2015 · Procedia - Social and Behavioral Sciences
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    • "This is congruent with the pattern of MCCB intercorrelations reported previously (August et al. 2012). There is growing evidence surrounding the separability of social and non-social cognition in schizophrenia (Allen et al. 2007; Sergi et al. 2007; Van Hooren et al. 2008; Williams et al. 2008; Bell et al. 2009; Hoe et al. 2012). Thus, the inclusion of tasks assessing social cognition in the current study may have contributed to the reduced fit of the hierarchical model in comparison to the 7-factor model. "
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