S121. REAL-WORLD FUNCTIONING IN SCHIZOPHRENIA: NEGATIVE SYMPTOMS AS A BRIDGE IN PATHWAYS FROM NEUROCOGNITION, SOCIAL COGNITION, AND FUNCTIONAL COMPETENCE
Notice bibliographique
Résumé
Schizophrenia is a debilitating disorder, with chronic impairments in multiple domains of life. Neurocognitive ability has been established as a reliable predictor of functional outcomes in schizophrenia, and thus is a frequent point of intervention. However, empirical evidence suggests that the path by which neurocognition is used to support functioning in real-world contexts is complex. While traditional cognitive remediation trials produce gains in neurocognition, few translate these gains to commensurate improvements in real-world functioning. Path analyses point to negative symptoms, social cognition, and competency in social and adaptive skills as additional factors that contribute to persistent functional disability in schizophrenia. To add to this complexity, it is possible the relevance of these barriers to functional recovery may vary depending on the diverse treatment goals of patients. We expand on this body of work by characterizing the indirect role of negative symptoms, social cognition, and skills competence in the relationship between neurocognition and individual domains of real-world functioning: work and residential. Clinically stable schizophrenia outpatients (N=507) were assessed for neurocognitive ability (MATRICS), functional competence (UPSA), social cognition (MSCEIT), as well as clinical symptoms (SANS, BPRS). Separate confirmatory path analysis models, with work and residential functioning as independent outcome variables (MSIF), were examined with functional competence and social cognition as level one mediators of neurocognition. Anhedonia and avolition were entered as independent mediators of both level one mediators and as potential direct predictors of neurocognition. Final models were determined iteratively and by examination of fit statistics. The final models had excellent fit statistics and explained a significant amount of variance in work (R2 = .35) and residential (R2 = .25) functioning. Neurocognition had an effect on everyday residential functioning (r = -.27), though it was fully mediated by functional competence (r = .58). Social cognition mediated neurocognition in both models, but the path from social cognition to everyday outcomes was fully mediated by anhedonia for residential functioning (r = .34) and avolition for work functioning (r = .55). The novel results indicate a complex, indirect relationship between neurocognition and functioning, with distinct paths forming via the mediators of social cognition and negative symptoms depending on the type of functional impairment. Specifically, weaker neurocognition is linked with poor work functioning, and this was found to be due to deficits in social cognition and volition, or willingness to pursue activities. Neurocognition is inversely related to residential functioning via deficits in social cognition and hedonic capacity, which represents the degree one can derive pleasure or reward from activities. These distinct pathways to functioning underscore the need for interventions to be tailored to individual differences in functional impairment; patients with prominent vocational disability may require concurrent skills training to augment motivation to independently approach work roles and responsibilities, while those with requirements to improve daily living at home may require auxiliary reward sensitivity training.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,023 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».