Relationship between cognitive and social dysfunction in schizophrenia
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)
- et al.
Schizophrenic individuals' cognitive functioning and performance in interpersonal interactions and skills training procedures
J. Psychiatr. Res.
(1994) - et al.
Cognitive correlates to social cue perception in schizophrenia
Psychiatry Res.
(1994) - et al.
Learning medication self-management skills in schizophrenia: Relationship with cognitive deficits and psychiatric symptoms
Behav. Ther.
(1994) - et al.
Neurocognitive deficits and social functioning in outpatients with schizophrenia
Schizophr. Res.
(1996) - et al.
Neuropsychological predictors of skills training for chronic psychiatric patients
Psychiatr. Res.
(1992) - et al.
Wisconsin Card Sorting Test and work performance in schizophrenia
Psychiatry Res.
(1995) - et al.
Prediction of social skill acquisition in schizophrenic and major affective disorder patients from memory and symptomatology
Psychiatry Res.
(1991) - et al.
RCT: Social treatments for schizophrenia, 12 month findings
Schizophr. Res.
(1995) - et al.
Signal detection indices in schizophrenia on a visual, auditory and bimodal continuous performance test
Schizophr. Res.
(1990) - Addington, J., Addington, D., in press. Neurocognitive and social functioning in schizophrenia. Schizophr....
Cognitive remediation for schizophrenia: Is it possible?
Schizophr. Bull.
Evaluation of social problem solving in schizophrenia
J. Abnorm. Psychol.
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
Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia
Schizophr. Bull.
The comparative efficacy and long term effect of clozapine treatment in neuropsychological test performance
Biol. Psychiatry
Cited by (54)
Chronic stress, structural exposures and neurobiological mechanisms: A stimulation, discrepancy and deprivation model of psychosis
2020, International Review of NeurobiologyCitation Excerpt :Conversely, increases in the counter to social fragmentation, social cohesion, are associated with decreased psychological distress even after controlling for factors such as neighborhood socioeconomic status (Erdem, Prins, Voorham, Van Lenthe, & Burdorf, 2015). Thus, structural exposures in the discrepancy domain, putatively impeding the building of social capital could particularly impact the marked social deficits facet of psychotic disorders (Addington, McCleary, & Munroe-Blum, 1998). Structural exposures in the “discrepancy” domain thus share overlapping components of impacted social capital, including lack of social cohesion, an impacted sense of trust and belonging, as well as less robust social networks and sense of support.
Neurocognition as a predictor of outcome in schizophrenia in the Northern Finland Birth Cohort 1966
2015, Schizophrenia Research: CognitionCitation Excerpt :Cognitive deficits in schizophrenia are related to functional outcomes, as shown in both cross-sectional (Fett et al., 2011; Green et al., 2000; Ventura et al., 2009) and longitudinal studies (Allott et al., 2011; Green et al., 2004; Ventura et al., 2011). However, some studies have failed to confirm this relationship (e.g. Addington et al., 1998; Johnstone et al., 1990; Verdoux et al., 2002). The association between neurocognition and clinical outcomes is not equally well documented.
Memory functioning and negative symptoms as differential predictors of social problem solving skills in schizophrenia
2013, Schizophrenia ResearchCitation Excerpt :Previous research has clearly shown that schizophrenia patients, at different illness severity levels and stages of illness (recent onset vs. chronic), have social problem solving deficits as measured by the Assessment of Interpersonal Problem Solving Skills (Addington and Addington, 2008; Stålberg et al., 2008; Vaskinn et al., 2009). Our findings are consistent with those previous reports that found verbal memory to be a key determinant of social problem solving (Addington et al., 1998; Addington and Addington, 1999, 2000). However, not all studies found an association with memory (Zanello et al., 2006).
Neurocognition and social skill in older persons with schizophrenia and major mood disorders: An analysis of gender and diagnosis effects
2010, Journal of NeurolinguisticsCitation Excerpt :Social skill and neurocognitive functioning were strongly associated with each other in the schizophrenia-schizoaffective disorder group, with appropriateness the only dimension of social skill that was not related to any of the cognitive measures (Table 6). These findings are consistent with prior research on the neurocognitive correlates of social skills in younger samples (Addington & Addington, 1999, 2000; Addington et al., 1998; Bellack et al., 1994; Bowen et al., 1994; Corrigan & Toomey, 1995; Dickinson et al., 2007; Hatashita-Wong et al., 2002; Kern, Green, & Satz, 1992; Mueser et al., 1991; Penn et al., 1995; Zanello et al., 2006). The canonical correlation analysis examining the associations between the social skills and neurocognitive measures in the schizophrenia-schizoaffective disorder sample indicated that one significant canonical variate was shared across the two sets of measures.
Elementary neurocognitive function, facial affect recognition and social-skills in schizophrenia
2009, Schizophrenia ResearchCognition and functional outcome among deaf and hearing people with schizophrenia
2007, Schizophrenia Research