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Environmental Adaptations Improve Everyday Action in Schizophrenia

Published online by Cambridge University Press:  01 June 2015

Rachel K. Kessler ,
Emma Rhodes  and
Tania Giovannetti
Rachel K. Kessler
Affiliation:
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Emma Rhodes
Affiliation:
Department of Psychology, Temple University, Philadelphia, Pennsylvania
Tania Giovannetti*
Affiliation:
Department of Psychology, Temple University, Philadelphia, Pennsylvania
*
Correspondence and reprint requests to: Tania Giovannetti, Temple University, Department of Psychology, 1701 N. 13th Street, Philadelphia, PA 19122. E-mail: [email protected].
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Abstract

Cognitive functioning, particularly executive functioning, is a strong predictor of functional outcomes in people with schizophrenia. Cognitive remediation has been shown to improve specific cognitive processes, but adjunctive interventions are required for meaningful gains in adaptive functioning, particularly in people with chronic illness. This study examined whether (and how) environmental adaptations, used without training, may circumvent cognitive difficulties and facilitate everyday task performance in individuals with chronic schizophrenia. Forty-two individuals with chronic schizophrenia/schizoaffective disorder were administered cognitive measures and two versions of the Naturalistic Action Test (NAT)—a standard version (ST-NAT), and a user-centered version (UC-NAT) that incorporated environmental adaptations designed to facilitate task performance. The NAT conditions were counterbalanced across participants. Analyses compared performance between the NAT versions and examined the cognitive correlates of each NAT condition. Individuals with schizophrenia made fewer errors on the UC-NAT as compared to the ST-NAT; this between-group difference was significant for all error types. Compared to the ST-NAT, the UC-NAT performance was not significantly associated with an executive function measure of planning. Environmental adaptations may be implemented without extensive training to improve everyday action in individuals with chronic schizophrenia. Environmental adaptations that reduce planning demands may be most effective in this population. (JINS, 2015, 21, 319–329)

Keywords

SchizophreniaCognitionEveryday actionCognitive remediationExecutive functionsEnvironmental adaptations
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 21 , Issue 5 , May 2015 , pp. 319 - 329
Copyright
Copyright © The International Neuropsychological Society 2015 

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References

Alain, C., McNeely, H.E., He, Y., Christensen, B.K., & West, R. (2002). Neurophysiological evidence of error-monitoring deficits in patients with schizophrenia. Cerebral Cortex, 12, 840–846.CrossRefGoogle ScholarPubMed
Amador, X.F., & Gorman, J.M. (1998). Psychopathologic domains and insight in schizophrenia. Psychiatric Clinics of North America, 21, 27–42.Google Scholar
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Andreasen, N.C. (1984a). Scale for the Assessment of Negative Symptoms (SANS). Iowa City: Department of Psychiatry, University of Iowa College of Medicine.Google Scholar
Andreasen, N.C. (1984b). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: Department of Psychiatry, University of Iowa College of Medicine.Google Scholar
Bates, A.T., Liddle, P.F., Kiehl, K.A., & Ngan, E.T. (2004). State depdendent changes in error monitoring in schizophrenia. Journal of Psychiatric Research, 38(1), 347–356.Google Scholar
Bettcher, B.M., & Giovannetti, T. (2009). From cognitive neuroscience to geriatric neuropsychology: What do current conceptualizations of the action error handling process mean for older adults? Neuropsychology Review, 19(1), 64–84.Google Scholar
Bowie, C.R., McGurk, S.R., Mausbach, B., Patterson, T.L., & Harvey, P.D. (2012). Combined cognitive remediation and functional skills training for schizophrenia: Effects on cognition, functional competence, and real-world behavior. American Journal of Psychiatry, 169(7), 710–718.CrossRefGoogle ScholarPubMed
Bowie, C.R., Grossman, M., Gupta, M., Oyewumi, L., & Harvey, P.D. (2014). Cognitive remediation in schizophrenia: Efficacy and effectiveness in patients with early versus long-term course of illness. Early Intervention in Psychiatry, 8(1), 32–38.Google Scholar
Buxbaum, L.J., Schwartz, M.F., Coslett, H.B., & Carew, T.G. (1995). Naturalistic action and praxis in callosal apraxia. Neurocase, 1, 3–17.Google Scholar
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). Delis Kaplan Executive Function System. San Antonio, TX: The Psychological Corporation.Google Scholar
Devlin, K.N., Giovannetti, T., Kessler, R.K., & Fanning, M.J. (2014). Commissions and omissions are dissociable aspects of everyday action impairment in schizophrenia. Journal of the International Neuropsychological Society, 8, 812–821.Google Scholar
Erdfelder, E., Faul, F., & Buchner, A. (1996). GPOWER: A general power analysis program. Behavior Research Methods, Instruments, & Computers, 28, 1–11.CrossRefGoogle Scholar
Evans, J.D., Heaton, R.K., Paulsen, J.S., Palmer, B.W., Patterson, T., & Jeste, D.V. (2003). The relationship of neuropsychological abilities to specific domains of functional capacity in older schizophrenia patients. Biological Psychiatry, 53, 422–430.Google Scholar
First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B.W. (1997). User’s guide for the Structured Clinical Interview for DSM-IV Axis I Disorders—Clinician Version. Washington DC: American Psychiatric Press.Google Scholar
Fitts, P.M., & Seeger, C.M. (1953). S-R compatibility: Spatial characteristics of stimulus and response codes. Journal of Experimental Psychology, 46, 199–210.Google Scholar
Folstein, M., Folstein, S., & McHugh, P. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Foti, D., Kotov, R., Bromet, E., & Hajcak, G. (2012). Beyond the broken error-related negativity: Functional and diagnostic correlates of error processing in psychosis. Biological Psychiatry, 71(10), 864–872.Google Scholar
Friedman, J.I., Harvey, P.D., Coleman, T., Moriarty, P.J., Bowie, C., Parrella, M.,& Davis, K.L. (2001). Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: A comparison with Alzheimer’s disease and normal aging. American Journal of Psychiatry, 158(9), 1441–1448.Google Scholar
Giovannetti, T., Libon, D.J., Buxbaum, L.J., & Schwartz, M.F. (2002). Naturalistic action impairments in dementia. Neuropsychologia, 40, 1220–1232.Google Scholar
Giovannetti, T., Libon, D.J., Brennan, L., Bettcher, B.M., Sestito, N., & Kessler, R.K. (2007). Environmental adaptations improve everyday action performance in Alzheimer’s disease: Empirical support from performance-based assessment. Neuropsychology, 21, 448–457.Google Scholar
Giovannetti, T., Bettcher, B.M., Brennan, L., Libon, D.J., Kessler, R.K., & Duey, K. (2008). Coffee with jelly or unbuttered toast: Commissions and omissions are dissociable aspects of everyday action impairment in Alzheimer’s disease. Neuropsychology, 22, 235–245.Google Scholar
Giovannetti, T., Seligman, S., Britnell, P., Brennan, L., & Libon, D.J. (2014). Differential effects of goal cues on everyday action errors in Alzheimer’s disease versus Parkinson’s disease dementia. Neuropsychology ([Epub ahead of print].Google ScholarPubMed
Green, M.F., Kern, R.S., Braff, D.L., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the right stuff? Schizophrenia Bulletin, 26, 119–136.Google Scholar
Green, M.F., Kern, R.S., & Heaton, R.K. (2004). Longitudinal studies of cognition and functional outcomes in schizophrenia: Implications for MATRICS. Schizophrenia Research, 72, 41–51.Google Scholar
Harvey, P.D., Silverman, J.M., Mohs, R.C., Parrella, M., White, L., Powchik, P., & Davis, K.L. (1999). Cognitive decline in late-life schizophrenia: A longitudinal study of geriatric chronically hospitalized patients. Biological Psychiatry, 45, 32–40.Google Scholar
Harvey, P.D., Parrella, M., White, L., Mohs, R.C., Davidson, M., & Davis, K.L. (1999). Convergence of cognitive and adaptive decline in late-life schizophrenia. Schizophrenia Research, 35, 77–84.CrossRefGoogle ScholarPubMed
Harvey, P.D., Green, M.F., Keefe, R.S.E., & Velligan, D.I. (2004). Cognitive functioning in schizophrenia: A consensus statement on its role in the definition and evaluation of effective treatments for the illness. Journal of Clinical Psychiatry, 65, 361–372.Google Scholar
Hemsley, D.R. (1976). Stimulus uncertainty, response uncertainty, and stimulus-response compatibility as determinants of schizophrenic reaction time performance. Bulletin of the Psychonomic Society, 8(6), 425–427.Google Scholar
Holt, D.V., Wolf, J., Funke, J., Weisbrod, M., & Kaiser, S. (2013). Planning impairments in schizophrenia: Specificity, task independence and functional relevance. Schizophrenia Research, 149(1), 174–179.Google Scholar
Ho, B.C., Andreasen, N., & Flaum, M. (1997). Dependence on public financial support early in the course of schizophrenia. Psychiatric Services, 48, 948–950.Google Scholar
Kaufman, A.S., & Kaufman, N.L. (2004). Kaufman Brief Intelligence Test-Second Edition. Circle Pines, MN: American Guidance Service.Google Scholar
Kern, R.S., Liberman, R.P., Kopelowicz, A., Mintz, J., & Green, M.F. (2002). Applications of errorless learning for improving work performance in persons with schizophrenia. American Journal of Psychiatry, 159(11), 1921–1926.Google Scholar
Kern, R.S., Liberman, R.P., Becker, D.R., Drake, R.E., Sugar, C.A., & Green, M.F. (2009). Errorless learning for training individuals with schizophrenia at a community mental health setting providing work experience. Schizophrenia Bulletin, 35(4), 807–815.Google Scholar
Kessler, R.K., Giovannetti, T., & MacMullen, L. (2007). Everyday action in schizophrenia: Performance patterns and underlying cognitive mechanisms. Neuropsychology, 21, 439–447.Google Scholar
Klapow, J.C., Evans, J., Patterson, T.L., Heaton, R.K., Koch, W.L., & Jeste, D.V. (1997). Direct assessment of functional status in older patients with schizophrenia. American Journal of Psychiatry, 154, 1022–1024.Google Scholar
Levine, B., Robertson, I.H., Clare, L., Carter, G., Hong, J., Wilson, B.A.,& Stuss, D.T. (2000). Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society, 6, 299–312.Google Scholar
Manly, T., Hawkins, K., Evans, J., Woldt, K., & Robertson, I.H. (2002). Rehabilitation of executive function: Facilitation of effective goal management on complex tasks using periodic auditory alerts. Neuropsychologia, 40, 271–281.Google Scholar
Mathalon, D.H., Fedor, M., Faustman, W.O., Gray, M., Askari, N., & Ford, J.M. (2002). Response-monitoring dysfunction in schizophrenia: An event-related brain potential study. Journal of Abnormal Psychology, 111, 22–41.Google Scholar
Mathalon, D.H., Jorgensen, K.W., Roach, B.J., & Ford, J.M. (2009). Error detection failures in schizophrenia: ERPSs and FMRI. International Journal of Psychophysiology, 73, 109–117.Google Scholar
Medalia, A., & Lim, R.W. (2004). Self-awareness of cognitive functioning in schizophrenia. Schizophrenia Research, 71, 331–338.Google Scholar
Medalia, A., & Saperstein, A.M. (2013). Does cognitive remediation for schizophrenia improve functional outcomes? Current Opinion in Psychiatry, 26(2), 151–157.Google Scholar
Norman, D. (1990). The design of everyday things. New York: Doubleday.Google Scholar
Patterson, T.L., Klapow, J.C., Eastham, J.H., Heaton, R.K., Evans, J.D., Koch, W.L., &Jeste, D.V. (1998). Correlates of functional status in older patients with schizophrenia. Psychiatry Research, 80, 41–52.Google Scholar
Reason, J.T. (1990). Human error. London: Cambridge University Press.Google Scholar
Rempfer, M.V., Hamera, E.K., Brown, C.E., & Cromwell, R.L. (2003). The relations between cognition and the independent living skill of shopping in people with schizophrenia. Psychiatry Research, 117(2), 103–112.Google Scholar
Rund, B.R., & Borg, N.E. (1999). Cognitive deficits and cognitive training in schizophrenic patients: A review. Acta Psychiatrica Scandinavica, 100, 85–95.Google Scholar
Schwartz, M.F., Buxbaum, L.J., Ferraro, M., Veramonti, T., & Segal, M. (2003). The Naturalistic Action Test. Bury St. Edmunds: Thames Valley Test Company.Google Scholar
Schwartz, M.F., Montgomery, M.W., Buxbaum, L.J., Lee, S.S., Carew, T.G., Coslett, H.B.,& Mayer, N. (1998). Naturalistic action impairment in closed head injury. Neuropsychology, 12, 13–28.Google Scholar
Schwartz, M.F., Segal, M., Veramonti, T., Ferrara, M., & Buxbaum, L. (2002). The Naturalistic Action Test: A standardized assessment for everyday action impairment. Neuropsychological Rehabilitation, 12, 311–339.CrossRefGoogle Scholar
Semkovska, M., Bedard, M.A., Godbout, L., Limoge, F., & Stip, E. (2004). Assessment of executive dysfunction during activities of daily living in schizophrenia. Schizophrenia Research, 69, 289–300.CrossRefGoogle ScholarPubMed
Semkovska, M., Stip, E., Godbout, L., Paquet, F., & Bedard, M.A. (2002). Behavioral disorganization in schizophrenia during a daily activity: The Kitchen Behavioral Scoring Scale. Brain and Cognition, 48, 546–553.Google Scholar
Sestito, N., Schmidt, K., Gallo, J., Giovannetti, T., & Libon, D. (2005). Using the Naturalistic Action Test (NAT) to assess everyday action in healthy older adults and patients with dementia. [Abstract] Journal of the International Neuropsychological Society, 11(Suppl. 1), 90–91.Google Scholar
Seter, C., Giovannetti, T., Kessler, R.K., & Worth, S. (2011). Everyday action planning in schizophrenia. Neuropsychological Rehabilitation, 21(2), 224–249.Google Scholar
Sevy, S., & Davidson, M. (1995). The cost of cognitive impairment in schizophrenia. Schizophrenia Research, 17, 1–3.Google Scholar
Sharma, T., & Antonova, L. (2003). Cognitive function in schizophrenia: Deficits, functional consequences, and future treatment. Psychiatric Clinics of North America, 26, 25–40.Google Scholar
Silver, H., & Goodman, C. (2007). Impairment in error monitoring predicts poor executive function in schizophrenia patients. Schizophrenia Research, 94, 156–163.Google Scholar
Silverstein, S.M., Knight, R.A., Schwarzkopf, S.B., West, L.L., Osborn, L.M., & Kamin, D. (1996). Stimulus configuration and context effects in perceptual organization in schizophrenia. Journal of Abnormal Psychology, 105(3), 410.Google Scholar
Silverstein, S.M., & Wilkniss, S.M. (2004). At issue: The future of cognitive rehabilitation of schizophrenia. Schizophrenia Bulletin, 30(4), 679–692.Google Scholar
Twamley, E.W., Jeste, D.V., & Bellack, A.S. (2003). A review of cognitive training in schizophrenia. Schizophrenia Bulletin, 29, 359–382.Google Scholar
Velligan, D.I., Bow-Thomas, C.C., Huntzinger, C., Ritch, J., Ledbetter, N., Prihoda, T.J., &Miller, A.L. (2000). Randomized controlled trial of the use of compensatory strategies to enhance adaptive functioning in outpatients with schizophrenia. American Journal of Psychiatry, 157, 1317–1323.Google Scholar
Velligan, D.I., Mahurin, R.K., Diamond, P.L., Hazleton, B.C., Eckert, S.L., & Miller, A.L. (1997). The functional significance of symptomatology and cognitive function in schizophrenia. Schizophrenia Research, 25, 21–31.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale-Third Edition. San Antonio, TX: The Psychological Corporation.Google Scholar
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H.C., & Evans, J.J. (1996). The Behavioural Assessment of the Dysexecutive Syndrome. Bury St. Edmunds, United Kingdom: Thames Valley Test Company.Google Scholar
Wykes, T., Huddy, V., Cellard, C., McGurk, S.R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. American Journal of Psychiatry, 168(5), 472–485.Google Scholar
Zayat, E., Rempfer, M., Gajewski, B., & Brown, C.E. (2011). Patterns of association between performance in a natural environment and measures of executive function in people with schizophrenia. Psychiatry Research, 187(1), 1–5.Google Scholar
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