Working memory dysfunctions predict social problem solving skills in schizophrenia

The current study aimed to examine the contribution of neurocognition and social cognition to components of social problem solving. Sixty-seven inpatients with schizophrenia and 31 healthy controls were administrated batteries of neurocognitive tests, emotion perception tests, and the Chinese Assessment of Interpersonal Problem Solving Skills (CAIPSS). MANOVAs were conducted to investigate the domains in which patients with schizophrenia showed impairments. Correlations were used to determine which impaired domains were associated with social problem solving, and multiple regression analyses were conducted to compare the relative contribution of neurocognitive and social cognitive functioning to components of social problem solving. Compared with healthy controls, patients with schizophrenia performed significantly worse in sustained attention, working memory, negative emotion, intention identification and all components of the CAIPSS. Specifically, sustained attention, working memory and negative emotion identification were found to correlate with social problem solving and 1-back accuracy significantly predicted the poor performance in social problem solving. Among the dysfunctions in schizophrenia, working memory contributed most to deficits in social problem solving in patients with schizophrenia. This finding provides support for targeting working memory in the development of future social problem solving rehabilitation interventions.

A randomized trial of family focused therapy with populations at clinical high risk for psychosis: effects on interactional behavior

OBJECTIVE

This study investigated whether family focused therapy (FFT-CHR), an 18-session intervention that consisted of psychoeducation and training in communication and problem solving, brought about greater improvements in family communication than enhanced care (EC), a 3-session psychoeducational intervention, among individuals at clinical high risk for developing psychosis.

METHOD

This study was conducted within a randomized controlled trial across 8 sites. We examined 10-min problem-solving discussions at baseline and 6-month reassessment among 66 adolescents and young adults and their parents. Trained coders who were blind to treatment and time of assessment achieved high levels of interrater reliability when evaluating family discussions on categories of calm-constructive and critical-conflictual behavior.

RESULTS

Individuals at high risk and their family members who participated in FFT-CHR demonstrated greater improvement from baseline to 6-month reassessment in constructive communication and decreases in conflictual behaviors during family interactions than those in EC. Participants in FFT-CHR showed greater increases from baseline to 6 months in active listening and calm communication and greater decreases in irritability and anger, complaints and criticism, and off-task comments compared to participants in EC. These changes occurred equally in high-risk participants and their family members.

CONCLUSIONS

A 6-month family skills training treatment can bring about significant improvement in family communication among individuals at high risk for psychosis and their parents. Future studies should examine the association between enhancements in family communication and reduced risk for the onset of psychosis among individuals at high risk.

Memory functioning and negative symptoms as differential predictors of social problem solving skills in schizophrenia

BACKGROUND

Neurocognition in general, and memory functioning in particular, as well as symptoms have all been shown to be related to social problem solving (SPS) in schizophrenia. However, few studies have directly compared the relative contribution of neurocognition vs. psychiatric symptoms to the components of SPS.

METHOD

Sixty outpatients (aged 21-65) who met DSM-IV criteria for schizophrenia or schizoaffective disorder were administered a broad battery of memory tests and assessed for severity of positive and negative symptoms as part of a baseline assessment of a study of psychiatric rehabilitation. Multiple regression analyses were used to examine the contribution of memory functioning vs. symptoms on receiving, processing, and sending skill areas of social problem solving ability.

RESULTS

An index of verbal learning was the strongest predictor of processing skills whereas negative symptoms were the strongest predictor of sending skills. Positive symptoms were not related to any of the three skill areas of social problem solving.

CONCLUSIONS

Memory functioning and psychiatric symptoms differentially predict selected areas of social problem solving ability in persons with schizophrenia. Consistent with other reports, positive symptoms were not related to social problem solving. Consideration of both neurocognition and negative symptoms may be important to the development of rehabilitation interventions in this area of functioning.

Assessing function and functional outcome in schizophrenia

The diagnosis of schizophrenia can only be made in the presence of a loss of functioning in domains such as employment, independent living, and social functioning. Accurately measuring functioning is central to research on the course of the disorder, treatment and rehabilitation outcomes, and biosocial factors in schizophrenia. Assessments of functional disability have described three dimensions of functioning: functional capacity, functional performance, and functional outcome. The "competence/performance" distinction refers to the observation that an individual may demonstrate an ability to perform a functional task (capacity) but may not do so in her own community environment (performance). Functional outcomes are the result of both capacity and performance. Several recent reviews have compared the characteristics, reliability, and validity of various functional assessment instruments. Two major initiatives are underway to gather additional comparative data about functional assessment strategies. Recently, both the recovery movement and the recognition of the role of environmental factors in functioning have raised questions about the conceptual content of the functioning construct (construct validity). For instance, several studies have demonstrated that features of functioning need not track together over the course of the illness. In addition, the notion of recovery emphasizes processes like community integration and subjective well-being that are not static outcomes but are continually evolving features of the life course in chronic illness. Findings on the dynamic role of environmental moderators such as support and opportunity also present challenges to scientific constructs. For these reasons and others, the ecological validity of functional assessments has become a central concern. Both the verisimilitude and veridicality of functional assessments can be empirically assessed, but to date very few studies have measured the extent to which functional measures accurately predict individuals' behavior in their usual environments. Observational studies in naturalistic environments are one important area for future research.

Reviewing the Theory and Practice of Occupational Therapy in Mental Health Rehabilitation

The delineation of evidence-based practices in supported employment for people with schizophrenia now represents a paradigm shift in the theory and practice of mental health rehabilitation. The principles and methods of traditional vocational rehabilitation and traditional mental health rehabilitation are giving way to evidence-based practices in supported employment, which are consistently proving two to three times more effective at producing competitive employment outcomes.

These practices include close coordination with optimal forms of mental health treatment and care and highly individualised forms of intensive supported employment. There is a focus on the vocational services being provided, whereas the traditional and currently prevailing approach follows a more gradual and stepwise process with less of an individual focus, and where individual characteristics are considered important predictors of vocational rehabilitation success.

This paradigm shift now challenges occupational therapists working in mental health rehabilitation to revise their theory and practice critically in order to support the implementation of evidence-based practices in supported employment for people with schizophrenia and related psychotic disorders. This article discusses how occupational therapists can adapt to this paradigm shift and revitalise their theory and practice in mental health rehabilitation.

Social problem-solving in high-functioning schizophrenia: specific deficits in sending skills

This study examined social problem-solving performance in high-functioning schizophrenia (n=26) and its relation to neurocognition. Ten healthy controls were used as a comparison group. Social problem-solving was assessed with the Assessment of Interpersonal Problem Solving Skills (AIPSS) method. The schizophrenia group was outperformed by healthy controls on all AIPSS measures, reaching statistical significance for sending skills. Exploration of the internal relationship between different aspects of social problem-solving showed that identification of an interpersonal problem (a receiving skill) was not correlated with formulating solutions to the problem (processing skills) or successfully role-playing solutions (interpersonal sending skills). Non-verbal performance in the role-play (an interpersonal sending skill) was not significantly correlated with identification of an interpersonal problem or the generation of solutions. This suggests a dissociation of social problem-solving processes. Social problem-solving was significantly associated with psychomotor speed, verbal learning, semantic fluency and cognitive flexibility. Clinical implications are that remediation of social problem-solving skills should focus on role-playing (nonverbal) interpersonal behaviors, rather than on verbally analyzing an interpersonal problem and clarifying alternative solutions.

Family problem solving interactions and 6-month symptomatic and functional outcomes in youth at ultra-high risk for psychosis and with recent onset psychotic symptoms: a longitudinal study

This study prospectively examined the relationship between social problem solving behavior exhibited by youths at ultra-high risk for psychosis (UHR) and with recent onset psychotic symptoms and their parents during problem solving discussions, and youths' symptoms and social functioning six months later. Twenty-seven adolescents were administered the Structured Interview for Prodromal Syndromes and the Strauss-Carpenter Social Contact Scale at baseline and follow-up assessment. Primary caregivers participated with youth in a ten minute discussion that was videotaped, transcribed, and coded for how skillful participants were in defining problems, generating solutions, and reaching resolution, as well as how constructive and/or conflictual they were during the interaction. Controlling for social functioning at baseline, adolescents' skillful problem solving and constructive communication, and parents' constructive communication, were associated with youths' enhanced social functioning six months later. Controlling for symptom severity at baseline, we found that there was a positive association between adolescents' conflictual communications at baseline and an increase in positive symptoms six months later. Taken together, findings from this study provide support for further research into the possibility that specific family interventions, such as problem solving and communication skills training, may improve the functional prognosis of at-risk youth, especially in terms of their social functioning.

Emotion perception and learning potential: mediators between neurocognition and social problem-solving in schizophrenia?

Social cognition and learning potential have been proposed as mediating variables between neurocognition and functional outcome in schizophrenia. The present study examined this relation in a schizophrenia group (N = 26) with normal IQ. Neurocognition was measured with a composite score from tests of verbal learning, psychomotor speed, and executive functioning. Functional outcome was defined as social problem-solving skills and assessed with a role-play test. Social cognition was indexed by tests of visual and auditory emotion perception; and learning potential by estimating a gain score using a triple administration of the WCST. Neurocognition was confirmed to be a strong predictor of social problem-solving, and emotion perception was related to both neurocognition and social problem-solving. When controlling for emotion perception, the association between neurocognition and social problem-solving was weakened, implying a mediating role of emotion perception. Learning potential was not significantly related to neurocognition or social problem-solving, and thus not found to mediate the studied relation. In conclusion, our study indicates that emotion perception is a mediator between neurocognition and functional outcome as assessed with a social problem-solving task and thus a key factor in understanding functional outcome of schizophrenia.