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.


Available from: Morris D Bell, Jul 22, 2014
    • "These results have important clinical implications because they suggest that an appropriate intervention program may be applied based on the profile of each group to meet the unique needs of each group. Examples for guidelines for such programs may be found in several studies [20, 28, 46] . These may improve employment rates of people with schizophrenia and thus contribute to their well-being, quality of life and recovery process [7] . "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Employment is a key element in recovery from schizophrenia. Yet 60%-80% of people with schizophrenia are not involved in work occupations. Factors influencing employment were explored mostly in community settings, while the recovery process begins already during hospitalization. Objective: The aim of the study was to investigate parameters that can distinguish during hospitalization between people with schizophrenia who will work in competitive employment, in sheltered employment or will not work after discharge. Methods: The research followed 104 participants from acute hospitalization to the community, six months after discharge, to obtain employment related data. The participants' cognitive abilities, schizophrenia symptoms, and functional capacity were evaluated during hospitalization. In addition, demography and illness related factors were collected. Results: The results indicate that persons with different employment statuses varied in several parameters during hospitalization. However, the most effective discriminant model includes negative symptoms, functional capacity measure and the number of hospitalizations. Conclusions: The study suggests that people with different employment statuses have unique characteristics already during hospitalization. In the future, appropriate rehabilitation programs may be suggested to each group based on these characteristics to promote employment among people with schizophrenia and contribute to recovery.
    No preview · Article · Oct 2015 · Work
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    • "Cognitive remediation has demonstrated empirical efficacy in the lasting improvement of cognitive processes such as attention, memory, executive function, problem solving, social cognition, and metacognition using behavioral skill-training intervention (Contreras et al., 2012; Medalia & Choi, 2009; Wykes, Huddy, Cellard, McGurk, & Czobor, 2011). Improved cognition has been shown in both TBI (Ashley et al., 2012; BenYishay & Diller, 1993; Cicerone, 2002; Galbiati et al., 2009) and SCZ (Krabbendam & Aleman, 2003; Kurtz et al., 2001; McGurk, Twamley, Sitzer, McHugo, & Mueser, 2007) and is associated with better psychosocial, vocational, and overall long-term function (Bell, Tsang, Greig & Bryson, 2009; Contreras et al., 2012; Kurtz, Seltzer, Fujimoto, Shagan, & Wexler, 2009; McGurk & Mueser, 2006; McGurk, Mueser, Derosa, & Wolfe, 2009; Wykes, 1994). Adjunctive therapy designed around these issues and further adapted on a patient-by-patient basis will likely be most efficacious in PFTBI. "
    [Show abstract] [Hide abstract] ABSTRACT: Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly. These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI.
    Full-text · Article · Oct 2015 · Frontiers in Human Neuroscience
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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: "
    [Show abstract] [Hide abstract] 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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