Elsevier

Schizophrenia Research

Volume 34, Issues 1–2, 9 November 1998, Pages 59-66
Schizophrenia Research

Relationship between cognitive and social dysfunction in schizophrenia

https://doi.org/10.1016/S0920-9964(98)00079-6Get rights and content

Abstract

This cross-sectional study examined the relationships between cognitive functioning, social functioning, and social problem solving in a sample of 30 outpatients with schizophrenia. The cognitive battery included measures of verbal ability, memory, executive functioning, visual-spatial ability, and attention. Social functioning was assessed with the Social Dysfunction Index (SDI) and the Social Adjustment Scale-II (SAS-II). Social problem solving was assessed with a video-based test, the Assessment of Interpersonal Problem-solving Skills (AIPSS). No significant association was found between social functioning as assessed by the SDI and the SAS-II and cognitive functioning. In multiple regression analyses, a measure of attention, the auditory Continuous Performance Test was a significant predictor of processing and sending skills, as assessed by the AIPSS (F=16.37, 9.23, p<0.001).

Introduction

Although it has clearly been shown that individuals with schizophrenia have impaired neurocognitive functioning, the actual impact of these deficits on daily living is unclear. Social interactions can be considered to be complex cognitive processes. They require individuals to recognize both faces and facial affect, to perceive and encode interpersonal cues, to remember past interactions, and to retrieve from memory appropriate responses. Social problem solving requires cognitive flexibility by which individuals are able to generate a range of interpersonal skills. Thus, it would be important to know which cognitive deficits eventually become `rate-limiting factors' for effective social and occupational functioning (Bellack, 1992). This is even more important in the light of increasing interest in cognitive remediation so that appropriate cognitive mediators can be targeted (Brenner et al., 1992).

Several studies have examined the relationship between different aspects of social and cognitive functioning. In a recent review of this topic, Green (1996)divided the literature into three areas of social functioning or outcome. These were community outcome, social problem solving and skill acquisition. Results of these studies suggested that verbal memory and card sorting (a measure of executive functioning and cognitive flexibility) were significant predictors of community functioning (Jaeger and Douglas, 1992; Goldman et al., 1993; Buchanan et al., 1994; Lysaker et al., 1995a). Additionally, Dickerson et al. (1996)reported that the social functioning of outpatient schizophrenia subjects was predicted by a combination of general organicity and negative symptoms. Verbal memory, vigilance and early visual processing were found to be significant predictors of social problem solving (Addington and Addington, in press; Bellack et al., 1994; Bowen et al., 1994; Corrigan et al., 1994a; Penn et al., 1995). Studies examining the relationship of cognitive functioning to the ability to acquire psychosocial skills found that verbal memory, vigilance and card sorting were consistently associated with skill acquisition (Mueser et al., 1991; Kern et al., 1992; Bowen et al., 1994; Corrigan et al., 1994b; Lysaker et al., 1995b).

Thus, verbal memory predicted social functioning in the community, problem-solving skills and skill acquisition. Vigilance was a reliable predictor of social problem solving and skill acquisition. Card sorting was consistently associated with performance on measures of community outcome, and inconsistently associated with skill acquisition and social problem solving (Green, 1996).

This present study is part of a larger randomized control trial assessing family psychoeducation and social skills training in schizophrenia (Munroe-Blum and McCleary, 1995; Munroe-Blum, 1996). At baseline, a subsample of the subjects were given a cognitive battery. The purpose of this part of the research was to determine whether cognitive functioning was related to social functioning and social-problem-solving ability. It was predicted that social problem solving would be associated with cognitive functioning as has been reported in other studies. Since the Social Dysfunction Index has not been used in previous studies, examinations of its potential associations with cognitive functioning are exploratory.

Section snippets

Subjects

Thirty outpatients (24 males and six females) with a SADS/RDC (Endicott and Spitzer, 1975; Spitzer et al., 1978) diagnosis of schizophrenia (n=23, 76.7%) or schizoaffective disorder (n=7, 23.3%) were recruited from outpatient and inpatient psychiatric treatment centres affiliated with McMaster University, in Hamilton, Ontario. The larger study recruited subjects in a post-acute, pre-chronic stage of illness and these inclusion requirements are reflected in the illness history and demographic

Results

The neurocognitive test scores were converted to z-scores and collapsed into the following seven summary scores: (1) WAIS-verbal tests, (2) immediate and delayed verbal memory, (3) visual memory, (4) WAIS-performance tests of non-verbal intellectual functioning, (5) executive functioning, (6) attention and (7) verbal fluency. For each summary score, the z-scores for each test were averaged (see Table 1).

Pearson product moment correlational analyses were conducted to assess the relationships

Discussion

In this study, although there were a few associations, cognitive functioning did not generally predict social functioning as assessed by the Social Dysfunction Index (Munroe-Blum et al., 1996) or the Social Adjustment Scale-II (Schooler et al., 1979). It is difficult to reconcile these findings with those in the literature because of the inconsistency in the use of measures of social functioning. Studies that reported verbal memory and card sorting as predictors of community functioning used

Acknowledgements

This study was supported by research grant R01-MH-43323 to Dr Heather Munroe-Blum from the National Institute of Mental Health, USA.

References (31)

  • A.S. Bellack

    Cognitive remediation for schizophrenia: Is it possible?

    Schizophr. Bull.

    (1992)
  • A.S. Bellack et al.

    Evaluation of social problem solving in schizophrenia

    J. Abnorm. Psychol.

    (1994)
  • M. Birchwood et al.

    The social functioning scale: The development and validation of a new scale of social adjustment for use in family intervention programs with schizophrenic patients

    Br. J. Psychiatry

    (1990)
  • H.D. Brenner et al.

    Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia

    Schizophr. Bull.

    (1992)
  • R.W. Buchanan et al.

    The comparative efficacy and long term effect of clozapine treatment in neuropsychological test performance

    Biol. Psychiatry

    (1994)
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