S121. REAL-WORLD FUNCTIONING IN SCHIZOPHRENIA: NEGATIVE SYMPTOMS AS A BRIDGE IN PATHWAYS FROM NEUROCOGNITION, SOCIAL COGNITION, AND FUNCTIONAL COMPETENCE
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.023 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".