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Multivariate predictors of social skills performance in middle-aged and older out-patients with schizophrenia spectrum disorders

Published online by Cambridge University Press:  06 September 2007

D. I. Sitzer ,
E. W. Twamley ,
T. L. Patterson  and
D. V. Jeste
D. I. Sitzer
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA
E. W. Twamley*
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA
T. L. Patterson
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA Division of Geriatric Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
D. V. Jeste
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA Division of Geriatric Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
*
*Address for correspondence: E. W. Twamley, Ph.D., Assistant Professor of Psychiatry, University of California, San Diego, 140 Arbor Drive, San Diego, CA 92103, USA. (Email: etwamley@ucsd.edu)
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Abstract

Background

Cognitive impairment and negative symptoms are two of the primary features of schizophrenia associated with poor social functioning. We examined the relationships between clinical characteristics, specific cognitive abilities and social skills performance in middle-aged and older out-patients with schizophrenia and normal comparison subjects.

Method

One hundred and ninety-four middle-aged and older schizophrenia out-patients and 60 normal comparison subjects were administered a standardized, performance-based measure of social skills using role-plays of various social situations [Social Skills Performance Assessment (SSPA)] and measures of current level of social contact (the Lehman Quality of Life Interview), psychiatric symptom severity [the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale (HAMD)], insight [the Birchwood Insight Scale (IS)] and cognitive functioning [the Mattis Dementia Rating Scale (DRS)].

Results

Patients demonstrated worse social skills compared with normal subjects. Better performance on the SSPA was associated with having less severe positive and negative symptoms, fewer social contacts, and better attention, initiation/freedom from perseveration, visuospatial ability, abstraction ability and memory. After controlling for demographic, clinical and insight-related factors, abstraction ability was the strongest predictor of social skills performance, followed by frequency of social contact.

Conclusions

Social functioning (as measured through direct observation of social skills performance) was related to cognitive ability in out-patients with schizophrenia. Addressing such cognitive impairment may help to improve social functioning and result in greater overall quality of life.

Keywords

Cognitionmemorypsychotic disorderssocial support
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 5 , May 2008 , pp. 755 - 763
Copyright
Copyright © Cambridge University Press 2007

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References

Addington, J, Addington, D (2000). Neurocognitive and social functioning in schizophrenia: a 2.5 year follow-up study. Schizophrenia Research 44, 47–56.CrossRefGoogle ScholarPubMed
Addington, J, McCleary, L, Munroe-Blum, H (1998). Relationship between cognitive and social dysfunction in schizophrenia. Schizophrenia Research 34, 59–66.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Bearden, CE, Rosso, IM, Hollister, JM, Sanchez, LE, Hadley, T, Cannon, TD (2000). A prospective cohort study of childhood behavioral deviance and language abnormalities as predictors of adult schizophrenia. Schizophrenia Bulletin 26, 395–410.CrossRefGoogle ScholarPubMed
Bellack, AS, Morrison, RL, Wixted, JT, Mueser, KT (1990). An analysis of social competence in schizophrenia. British Journal of Psychiatry 156, 809–818.CrossRefGoogle ScholarPubMed
Bellack, AS, Sayers, M, Mueser, KT, Bennett, M (1994). Evaluation of social problem solving in schizophrenia. Journal of Abnormal Psychology 103, 371–378.CrossRefGoogle ScholarPubMed
Birchwood, M, Smith, J, Drury, V, Healy, J, Macmillan, F, Slade, M (1994). A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica 89, 62–67.Google Scholar
Bleuler, E (1943). Textbook of Psychiatry. Springer: Berlin, Germany.Google Scholar
Cannon, M, Caspi, A, Moffitt, TE, Harrington, H, Taylor, A, Murray, RM, Poulton, R (2002). Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Archives of General Psychiatry 59, 449–456.CrossRefGoogle ScholarPubMed
Chino, B, Mizuno, M, Nemoto, T, Yamashita, C, Kashima, H (2006). Relation between social functioning and neurocognitive test results using the Optional Thinking Test in schizophrenia. Psychiatry and Clinical Neurosciences 60, 63–69.Google Scholar
Cohen, AS, Forbes, CB, Mann, MC, Blanchard, JJ (2006). Specific cognitive deficits and differential domains of social functioning impairment in schizophrenia. Schizophrenia Research 81, 227–238.CrossRefGoogle ScholarPubMed
Erlenmeyer-Kimling, L, Rock, D, Roberts, SA, Janal, M, Kestenbaum, C, Cornblatt, B, Adamo, UH, Gottesman, II (2000). Attention, memory, and motor skills as childhood predictors of schizophrenia-related psychoses: the New York High-Risk Project. American Journal of Psychiatry 157, 1416–1422.CrossRefGoogle ScholarPubMed
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119–136.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Harvey, PD, Sukhodolsky, D, Parrella, M, White, L, Davidson, M (1997). The association between adaptive and cognitive deficits in geriatric chronic schizophrenia patients. Schizophrenia Research 27, 211–218.CrossRefGoogle Scholar
Hatashita-Wong, M, Smith, TE, Silverstein, SM, Hull, JW, Willson, DF (2002). Cognitive functioning and social problem-solving skills in schizophrenia. Cognitive Neuropsychiatry 7, 81–95.Google Scholar
Heaton, R, Paulsen, JS, McAdams, LA, Kuck, J, Zisook, S, Braff, D, Harris, J, Jeste, DV (1994). Neuropsychological deficits in schizophrenia: relationship to age, chronicity and dementia. Archives of General Psychiatry 51, 469–476.Google Scholar
Heinrichs, RW (2005). The primacy of cognition in schizophrenia. American Psychologist 60, 229–242.CrossRefGoogle ScholarPubMed
Kay, SR, Opler, LA, Fiszbein, A (eds) 1987). Positive and Negative Syndrome Scale (PANSS) Rating Manual. Social and Behavioral Sciences Documents: San Rafael, CA.Google Scholar
Lehman, AF (1996). Measures of quality of life among persons with severe and persistent mental disorders. Social Psychiatry and Psychiatric Epidemiology 31, 78–88.Google Scholar
Loewenstein, DA, Amigo, E, Duara, R, Guterman, A, Hurwitz, D, Berkowitz, N, Wilkie, F, Weinberg, G, Black, B, Gittelman, B (1989). A new scale for the assessment of functional status in Alzheimer's disease and related disorders. Journal of Gerontology 44, 114–121.Google Scholar
Marder, SR, Fenton, W (2004). Measurement and treatment research to improve cognition in schizophrenia: NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia. Schizophrenia Research 72, 5–9.CrossRefGoogle ScholarPubMed
Mattis, S (1973). Dementia Rating Scale. Psychological Assessment Resources Inc.: Odessa, FL.Google Scholar
Miura, Y, Mizuno, M, Yamashita, C, Watanabe, K, Murakami, M, Kashima, H (2004). Expressed emotion and social functioning in chronic schizophrenia. Comprehensive Psychiatry 45, 469–474.CrossRefGoogle ScholarPubMed
Mueser, KT, Bellack, AS, Douglas, MS, Morrison, RL (1991). Prevalence and stability of social skill deficits in schizophrenia. Schizophrenia Research 5, 167–176.Google Scholar
Niemi, LT, Suvisaari, JM, Tuulio-Henriksson, A, Lönnqvist, JK (2003). Childhood developmental abnormalities in schizophrenia: evidence from high-risk studies. Schizophrenia Research 60, 239–258.Google Scholar
Patterson, TL, Goldman, S, McKibbin, CL, Hughs, T, Jeste, DV (2001). UCSD performance-based skills assessment (UPSA): development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin 27, 235–245.CrossRefGoogle ScholarPubMed
Patterson, TL, Klapow, JC, Eastham, JH, Heaton, RK, Evans, JD, Koch, WL, Jeste, DV (1998). Correlates of functional status in older patients with schizophrenia. Psychiatry Research 80, 41–52.CrossRefGoogle ScholarPubMed
Patterson, TL, Lacro, J, McKibbin, CL, Moscona, S, Hughs, T, Jeste, DV (2002). Medication management ability assessment: results from a performance-based measure in older outpatients with schizophrenia. Journal of Clinical Psychopharmacology 22, 11–19.CrossRefGoogle ScholarPubMed
Penn, LD, Hope, AD, Spaulding, W, Kucera, J (1994). Social anxiety in schizophrenia. Schizophrenia Research 11, 277–284.CrossRefGoogle ScholarPubMed
Pinkham, AE, Penn, DL (2006). Neurocognitive and social cognitive predictors of interpersonal skill in schizophrenia. Psychiatry Research 143, 167–178.CrossRefGoogle ScholarPubMed
Reeder, C, Newton, E, Frangou, S, Wykes, T (2004). Which executive skills should we target to affect social functioning and symptom change? A study of a cognitive remediation therapy program. Schizophrenia Bulletin 30, 87–100.Google Scholar
Twamley, EW, Doshi, RR, Nayak, GV, Palmer, BW, Golshan, S, Heaton, RK, Patterson, TL, Jeste, DV (2002). Generalized cognitive impairments, ability to perform everyday tasks, and level of independence in community living situations of older patients with psychosis. American Journal of Psychiatry 159, 2013–2020.Google Scholar
Twamley, EW, Jeste, DV, Bellack, AS (2003). A review of cognitive training in schizophrenia. Schizophrenia Bulletin 29, 359–382.Google Scholar
van Beilen, M, Kiers, HA, Bou, A, van Zomeren, EH, Withaar, FK, Arends, J, van den Bosch, RJ (2003). Cognitive deficits and social functioning in schizophrenia: a clinical perspective. Clinical Neuropsychology 17, 507–514.Google Scholar
Yamashita, C, Mizuno, M, Nemoto, T, Kashima, H (2005). Social cognitive problem-solving in schizophrenia: associations with fluency and verbal memory. Psychiatry Research 134, 123–129.CrossRefGoogle ScholarPubMed
Zanello, A (2006). Cognitive functions related to interpersonal problem-solving skills in schizophrenic patients compared with healthy subjects. Psychiatry Research 142, 67–78.CrossRefGoogle ScholarPubMed