تاثیر شناخت اجتماعی بر روی عملکرد روزانه در اسکیزوفرنی: مطالعه اعتبار تدریجی و اثر میانجی
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
|30211||2015||7 صفحه PDF||سفارش دهید|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Psychiatry Research, Volume 225, Issue 3, 28 February 2015, Pages 374–380
While the role of impaired neurocognition in accounting for functional outcome in schizophrenia is generally established, the influence of social cognition on this relationship is far from clear. This study aims to explore in depth the nature of the relationship between neurocognition, social cognition and daily functioning in people with schizophrenia. Twenty-one individuals diagnosed with schizophrenia and 15 controls completed the assessment of symptom severity, neuropsychological status, social cognition (Theory of Mind and affect processing) and other functional measures. A statistical mediation model based on hierarchical regression analyses was used to establish the mediation path with significant variables. Social cognition played a mediating role between neurocognition and functioning, accounting for significant trends in incremental variance in specific functional indexes (interpersonal behavior and employment/occupation). Consequently, this study adds to the evidence underlining the importance of targeting not only social cognitive or neurocognitive functions but to combine both interventions to reveal the best daily functioning results in schizophrenia patients.
Existing research shows that individuals with schizophrenia show substantial deficits in social cognitive domains, including emotion processing, social perception, social knowledge, and Theory of Mind (Bora et al., 2009, Kohler et al., 2010 and Savla et al., 2013). Growing evidence indicates that impairments in social cognition may precede onset of the disorder, remain stable throughout the course of illness (Comparelli et al., 2013) and are present in first-degree relatives of people with schizophrenia (Lavoie et al., 2013), suggesting that social cognitive impairments in schizophrenia are likely core features of the illness and not simply a result of medication side-effects or clinical episodes. In addition to these findings, interest in social cognition in schizophrenia has increased because it appears to be a key determinant of daily functioning. Consensus exists that social cognition is related to, though distinct from, (nonsocial) neurocognition (such as attention, memory, and problem solving) (Allen et al., 2007). Several studies suggest that social cognition may contribute unique variance in functional outcomes above and beyond that provided by neurocognition, and may have a greater impact than cognition on social outcomes (Fett et al., 2011). This has stimulated a NIMH-sponsored workshop report to specifically recommend that researchers further examine the relationships between social cognitive domains and functional outcomes, as well as exploring the stability and correlates of social cognitive impairments (Green et al., 2008). Despite evidence of social cognition being a determinant of daily functioning in schizophrenia, many of the relevant studies are mainly based on correlational analysis (Couture et al., 2006). Unfortunately, results from such studies do not provide information about the directionality of relationships, and explanatory models of associations remain heterogeneous. A methodological approach that has gained attention more recently considers social cognitive processes as a potential mediator between neurocognition and functional outcome. Nevertheless, there is substantial variability in the type of statistical analysis employed, with studies using Structural Equation Modeling (SEM) (Sergi et al., 2006 and Rassovsky et al., 2011), path analysis (Brekke et al., 2005 and Gard et al., 2009) or regression analysis (Addington et al., 2006). In addition, research diverged in the statistical procedure used to test mediation effects. While some studies estimated the parameters of the mediation model controlling the direct effect of neurocognition on functional outcome (Sergi et al., 2006), others did not (Gard et al., 2009). Finally, when social cognition is measured in studies by means of correlational analyses (including regression analysis, path analysis and SEM), to have adequate range properties is crucial. However, most of these studies have employed measures with unknown or questionable psychometric properties and, in numerous cases, have only focused on one specific social cognition domain. Therefore, a statistical mediation approach including a wide range of measures is lacking (Schmidt et al., 2011). The issue of differential associations between social cognition, neurocognition, and functional outcomes is important for identifying specific cognitive domains as possible targets for treatment intervention (Gold, 2004). Following the indication of the international Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus in which each domain has to be composed by two different tests at least (Nuechterlein et al., 2008), we conduct exploratory analyses of composite scores to elucidate the mediation model of the relationship between a wide range of well-defined neurocognitive and social cognitive measures (Pinkham et al., 2013) and daily functioning (Leifker et al., 2011) in a sample of stable outpatients with schizophrenia. We studied a sample of predominant negative symptoms because they have shown to be more consistently associated with functional outcome than positive symptoms, but have garnered much less attention (Ventura et al., 2009). Specifically, we examined (1) whether the social cognitive performance uniquely accounts for incremental variance in daily functioning, independently of neurocognitive performance and psychiatric symptom severity, and (2) whether social cognitive performance mediates the relationship between neurocognitive performance and daily functioning.
نتیجه گیری انگلیسی
The demographic characteristics of schizophrenic participants (n=21) and healthy control participants (n=15) are shown in Table 1. All schizophrenic participants were taking antipsychotic medication with a mean (S.D.) chlorpromazine equivalent dose of 248.53 (115.18) mg/day. Table 1. Demographic and clinical characteristics of the sample and scores on neurocognition, social cognition, and functioning. Schizophrenia (n=21) Healthy control (n=15) Statistic p Gender (male/female)a n=15/6 n=10/5 χ2=3.55 0.060 Age (years)b 39.24 (10.54) 38.13 (14.28) t=0.26 0.791 Years of educationb 16.05 (3.42) 17.93 (2.37) t=−1.83 0.075 Hospitalizationsb 1.86 (1.27) – – – Length of illness (years)b 13.33 (5.3) – – – Chlorpromazine equivalents (mg)b 248.53 (115.18) – – – Symptomsb PANSS-Positive 12.75 (3.19) – – – PANSS-Negative 22.80 (7.87) – – – PANSS-General pathology 38.85 (6.08) – – – Neurocognitionc General intelligence 52.55 (4.53) 58.60 (6.06) t=−3.38 0.002 Attention/vigilance 45.55 (4.92) 51.12 (10.60) t=−2.11 0.042 Working memory 50.19 (8.15) 54.47 (6.84) t=−1.66 0.107 Psychomotor speed 47.48 (6.85) 56.63 (4.45) t=−4.53 <0.001 Verbal memory 43.39 (8.63) 57.75 (5.78) t=−5.60 <0.001 Non-verbal learning 44.95 (6.62) 55.20 (7.96) t=−4.21 <0.001 Executive function 47.67 (6.27) 56.98 (4.52) t=−0.90 <0.001 Social cognitionb Hinting task 15.29 (2.07) 18.80 (1.26) t=−5.81 <0.001 ER-40 31.14 (3.62) 35.87 (2.20) t=−4.48 <0.001 Eyes test 22.43 (4.78) 28.73 (3.75) t=−4.25 <0.001 Functioningb SFS-Total 100.67 (8.98) 115.73 (4.39) t=−5.99 <0.001 GAF-Total 65.71 (8.10) 100.00 (0.00) t=−16.31 <0.001 a Frequency. b Mean (S.D.). c T-Scores (Mean=50; S.D.=10). Table options 3.1. Correlations with functioning, neurocognition, and psychiatric symptom severity Correlations between social cognition and functioning were significant for all social cognitive measures, while better performance on the Hinting, Reading the Mind in the Eyes, and ER-40 tasks were associated with a higher rating on the SFS (all r=0.50–0.64, all P<0.01) and GAF (all r=0.58–0.74, all P<0.001). Among SFS sub-scores, correlations of all social cognitive measures were significant for all subdomains, except SFS Independence-performance (all r=0.13–0.25; all P>0.05). ER-40 did not correlate with Recreation (r=0.25; P>0.05). Social cognitive measures had a significantly stronger association with all neurocognitive domains (all r=0.39 to 0.79, all P׳s<0.001), except attention/vigilance (all r=0.05 to 0.29; all P>0.05). ER-40 did not correlate with working memory (r=0.25; P>0.05). There was a trend-level negative correlation between the Hinting task and the PANSS Positive Factor (r=−0.49, P<0.05). There were no other significant correlations between social cognitive measures and psychiatric symptom severity. (See Supplementary material 1).