Abstract
Treatment research in schizophrenia is focused on the development of pharmacological agents that are effective for improving community functioning and decreasing disability. As a result of this recent focus, there has been substantial activity for developing instruments that can measure functioning as well as the psychopathological domains that are related to functioning. Issues in selecting measures of real-world functioning include ensuring that the instrument measures the full range of possible outcomes and differentiating symptoms from functioning. For many treatment studies it is unrealistic to expect a change in actual functioning. Most treatment trials are too brief to permit subjects to change their level of vocational or social functioning. In addition, real-world functioning is influenced by factors such as an individual’s financial status or the availability of community services. This has led to the use of functional capacity measures which monitor an individual’s ability to perform functionally meaningful tasks even if they do not complete these tasks. Attention has also focused on interview-based measures of cognition and negative symptoms. Both of these psychopathological domains are related to functioning and both are the focus of drug development.
Recent drug development has focused on the development of agents that target domains of psychopathology that may lead to improved functioning. This focus contrasts with the development of first and second-generation antipsychotics; these drugs were considered effective when they treated psychotic symptoms such as auditory hallucinations, suspiciousness, delusions, and disorganized behaviors. Treating these symptoms was important for reducing suffering and for allowing many patients to live in their communities. On the other hand, these agents had relatively modest effects on the ability of patients to function in their communities. This new focus on functioning has led to the development of new instruments for measuring functioning as well as the psychopathological domains that appear to be related to impaired functioning. This review will discuss the challenges that instrument developers have faced in designing these new instruments as well as the current state of the field. The measurement of typical psychopathology—particularly psychosis will not be discussed. The measurement of cognition and social cognition is discussed in the review by Keefe and Harvey (2012) Cognitive deficits in schizophrenia. In: Geyer MA, Gross G, Eds. In: Novel antischizophrenia treatments. Handbook of experimental pharmacology. Springer, Heidelberg.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American Psychiatric Association (1994) Diagnostic and statistical manual of mential disorders, 4th edn. American Psychiatric Association Press, Arlington, VA
Andreasen NC (1983) Scale for the assessment of negative symptoms (SANS). Br J Psychiatr 154:672–676
Axelrod BN, Goldman RS, Alphs LD (1993) Validation of the 16-item negative symptom assessment. J Psychiatr Res 7:253–258
Axelrod BN, Goldman RS, Woodard JL, Alphs LD (1994) Factor structure of the negative symptom assessment. Psychiatr Res 52:173–9
Bellack AS, Brown CH, Thomas-Lohrman S (2006) Psychometric characteristics of role-play assessments of social skill in schizophrenia. Behav Ther 37:339–52
Blanchard JJ, Kring AM, Horan WP, Gur R (2010) Toward the Next Generation of Negative Symptom Assessments: The Collaboration to Advance Negative Symptom Assessment in Schizophrenia. Schizophr Bull
Bowie CR, Twamley EW, Anderson H, Halpern B, Patterson TL, Harvey PD (2007) Self-assessment of functional status in schizophrenia. J Psychiatr Res 41:1012–8
Buchanan RW, Davis M, Goff D, Green MF, Keefe RS, Leon AC, Nuechterlein KH, Laughren T, Levin R, Stover E, Fenton W, Marder SR (2005) A summary of the FDA-NIMH-MATRICS workshop on clinical trial design for neurocognitive drugs for schizophrenia. Schizophr Bull 31:5–19
Castle DJ, Morgan V (2008) Epidemiology. In: Mueser KT, Jeste DV (eds) Clinical handbook of schizophrenia. Guilford, New York, pp 14–24
Green MF, Nuechterlein KH, Kern RS, Baade LE, Fenton WS, Gold JM, Keefe RS, Mesholam-Gately R, Seidman LJ, Stover E, Marder SR (2008) Functional co-primary measures for clinical trials in schizophrenia: results from the MATRICS Psychometric and Standardization Study. Am J Psychiatry 165:221–8
Green MF, Schooler NR, Kern RS, Frese FJ, Granberry W, Harvey PD, Karson CN, Peters N, Stewart M, Seidman LJ, Sonnenberg J, Stone WS, Walling D, Stover E, Marder SR (2011) Evaluation of functionally meaningful measures for clinical trials of cognition enhancement in schizophrenia. Am J Psychiatry 168(4):400–7
Harvey PD, Velligan DI (2011) International assessment of functional skills in people with schizophrenia. Innov Clin Neurosci 8:15–8
Harvey PD, Serper MR, White L, Parrella MJ, McGurk SR, Moriarty PJ, Bowie C, Vadhan N, Friedman J, Davis KL (2001) The convergence of neuropsychological testing and clinical ratings of cognitive impairment in patients with schizophrenia. Compr Psychiatry 42:306–13
Harvey PD, Raykov T, Twamley EW, Vella L, Heaton RK, Patterson TL (2011) Validating the measurement of real-world functional outcomes: phase I results of the VALERO study. Am J Psychiatry 168:1195–201
Heinrichs DW, Hanlon TE, Carpenter WT Jr (1984) The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 10:388–98
Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–76
Kee KS, Horan WP, Salovey P, Kern RS, Sergi MJ, Fiske AP, Lee J, Subotnik KL, Nuechterlein K, Sugar CA, Green MF (2009) Emotional intelligence in schizophrenia. Schizophr Res 107:61–8
Keefe RS, Poe M, Walker TM, Kang JW, Harvey PD (2006) The Schizophrenia Cognition Rating Scale: an interview-based assessment and its relationship to cognition, real-world functioning, and functional capacity. Am J Psychiatry 163:426–32
Kirkpatrick B, Fenton WS, Carpenter WT Jr, Marder SR (2006) The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 32:214–9
Kirkpatrick B, Strauss GP, Nguyen L, Fischer BA, Daniel DG, Cienfuegos A, Marder SR (2010) The brief negative symptom scale: psychometric properties. Schizophr Bull 37(2):300–5
Leifker FR, Bowie CR, Harvey PD (2009) Determinants of everyday outcomes in schizophrenia: the influences of cognitive impairment, functional capacity, and symptoms. Schizophr Res 115:82–7
Leifker FR, Patterson TL, Heaton RK, Harvey PD (2011) Validating measures of real-world outcome: the results of the VALERO expert survey and RAND panel. Schizophr Bull 37:334–43
Lindenmayer JP, Bernstein-Hyman R, Grochowski S (1994) A new five factor model of schizophrenia. Psychiatr Q 65:299–322
Loeb P (1996) Independent living scales manual. Psychological Corporation, New York
Marder SR, Davis JM, Chouinard G (1997) The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials. J Clin Psychiatry 58:538–46
Niv N, Cohen AN, Sullivan G, Young AS (2007) The MIRECC version of the Global Assessment of Functioning scale: reliability and validity. Psychiatr Serv 58:529–35
Patterson TL, Goldman S, McKibbin CL, Hughs T, Jeste DV (2001) UCSD performance-based skills assessment: development of a new measure of everyday functioning for severely mentally ill adults. Schizophr Bull 27:235–45
Rosen A, Hadzi-Pavlovic D, Parker G (1989) The life skills profile: a measure assessing function and disability in schizophrenia. Schizophr Bull 15:325–37
Schneider LC, Struening EL (1983) SLOF: a behavioral rating scale for assessing the mentally ill. Soc Work Res Abstr 19:9–21
Subotnik KL, Nuechterlein KH, Green MF, Horan WP, Nienow TM, Ventura J, Nguyen AT (2006) Neurocognitive and social cognitive correlates of formal thought disorder in schizophrenia patients. Schizophr Res 85:84–95
Velligan DI, Diamond P, Glahn DC, Ritch J, Maples N, Castillo D, Miller AL (2007) The reliability and validity of the Test of Adaptive Behavior in Schizophrenia (TABS). Psychiatry Res 151:55–66
Velligan DI, Alphs L, Lancaster S, Morlock R, Mintz J (2009) Association between changes on the Negative Symptom Assessment scale (NSA-16) and measures of functional outcome in schizophrenia. Psychiatry Res 169:97–100
Velligan DI, Rubin M, Fredrick MM, Mintz J, Nuechterlein KH, Schooler NR, Jaeger J, Peters NM, Buller R, Marder SR, Dube S (2010) The cultural adaptability of intermediate measures of functional outcome in schizophrenia. Schizophr Bull 38(3):630–41
Ventura J, Reise SP, Keefe RS, Baade LE, Gold JM, Green MF, Kern RS, Mesholam-Gately R, Nuechterlein KH, Seidman LJ, Bilder RM (2010) The Cognitive Assessment Interview (CAI): development and validation of an empirically derived, brief interview-based measure of cognition. Schizophr Res 121:24–31
Wallace CJ, Liberman RP, Tauber R, Wallace J (2000) The independent living skills survey: a comprehensive measure of the community functioning of severely and persistently mentally ill individuals. Schizophr Bull 26:631–58
Wykes T, Sturt E (1986) The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS schedule. Br J Psychiatry 148:1–11
Acknowledgements
This work was supported by the Desert Pacific MIRECC.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Marder, S.R. (2012). Clinical Instruments to Evaluate and Guide Treatment in Schizophrenia. In: Geyer, M., Gross, G. (eds) Novel Antischizophrenia Treatments. Handbook of Experimental Pharmacology, vol 213. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25758-2_1
Download citation
DOI: https://doi.org/10.1007/978-3-642-25758-2_1
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-25757-5
Online ISBN: 978-3-642-25758-2
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)