Hostname: page-component-5cf477f64f-rdph2 Total loading time: 0 Render date: 2025-03-31T04:51:23.858Z Has data issue: false hasContentIssue false
  • English
  • Français

The causal relationships between neurocognition, social cognition and functional outcome over time in schizophrenia: a latent difference score approach

Published online by Cambridge University Press:  05 April 2012

M. Hoe ,
E. Nakagami ,
M. F. Green  and
J. S. Brekke
M. Hoe*
Affiliation:
Department of Social Welfare, College of Social Science, Keimyung University, Daegu, South Korea
E. Nakagami
Affiliation:
School of Social Work, University of Southern California, Los Angeles, CA, USA
M. F. Green
Affiliation:
Department of Psychiatry and Biobehavioral Science, University of California at Los Angeles, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
J. S. Brekke
Affiliation:
School of Social Work, University of Southern California, Los Angeles, CA, USA
*
*Address for correspondence: M. Hoe, Ph.D., Assistant Professor, Department of Social Welfare, College of Social Science, Keimyung University, 2800 Dalgubeoldearo, Dalseo-Gu, Daegu 704-701, South Korea. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Social cognition has been identified as a significant construct for schizophrenia research with relevance to diagnosis, assessment, treatment and functional outcome. However, social cognition has not been clearly understood in terms of its relationships with neurocognition and functional outcomes. The present study sought to examine the empirical independence of social cognition and neurocognition; to investigate the possible causal structure among social cognition, neurocognition and psychosocial functioning.

Method

The sample consists of 130 individuals diagnosed with schizophrenia. All participants were recruited as they were admitted to four community-based psychosocial rehabilitation programs. Social cognition, neurocognition and psychosocial functioning were measured at baseline and 12 months. The empirical independence of social cognition and neurocognition was tested using confirmatory factor analysis (CFA) and the possible causal structure among social cognition, neurocognition and psychosocial functioning was investigated using latent difference score (LDS) analysis.

Results

A two-factor model of social cognition and neurocognition fit the data very well, indicating the empirical independence of social cognition, whereas the longitudinal CFA results show that the empirical independence of neurocognition and social cognition is maintained over time. The results of the LDS analysis support a causal model that indicates that neurocognition underlies and is causally primary to social cognition, and that neurocognition and social cognition are causally primary to functional outcome.

Conclusions

Social cognition and neurocognition could have independent and distinct upward causal effects on functional outcome. It is also suggested that the approaches for remediation of neurocognition and social cognition might need to be distinct.

Keywords

Causal relationshipneurocognitionpsychosocial rehabilitationschizophreniasocial cognition
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 11 , November 2012 , pp. 2287 - 2299
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J, Saeedi, H, Addington, D (2006). Facial affect recognition: a mediator between cognitive and social functioning in psychosis? Schizophrenia Research 85, 142–150.CrossRefGoogle ScholarPubMed
Allen, DN, Strauss, GP, Donohue, B, van Kammen, DP (2007). Factor analytic support for social cognition as a separable cognitive domain in schizophrenia. Schizophrenia Research 93, 325–333.CrossRefGoogle ScholarPubMed
Arbuckle, JL (2006). Amos 6.0 User's Guide (http://cmsprod.bgu.ac.il/NR/rdonlyres/DBEE38D3-C8C2-4129-BAFD-43E1EA786661/0/Amos60UsersGuide.pdfgelezenop). Accessed 11 January 2007.Google Scholar
Baron-Cohen, S, Wheelwright, S, Hill, J, Raste, Y, Plumb, I (2001). The ‘reading the mind in the eyes’ test revised version: a study with normal adults and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry 42, 241–251.CrossRefGoogle ScholarPubMed
Bellack, AS, Blanchard, JJ, Mueser, KT (1996). Cue availability and affect perception in schizophrenia. Schizophrenia Bulletin 22, 535–544.CrossRefGoogle ScholarPubMed
Brekke, JS, Hoe, M, Green, MF (2009). Neurocognitive change, functional change and service intensity during community-based psychosocial rehabilitation for schizophrenia. Psychological Medicine 39, 1637–1647.CrossRefGoogle ScholarPubMed
Brekke, JS, Hoe, M, Long, J, Green, MF (2007). How neurocognition and social cognition influence functional change during community-based psychosocial rehabilitation for individuals with schizophrenia. Schizophrenia Bulletin 33, 1247–1256.CrossRefGoogle ScholarPubMed
Brekke, JS, Kay, DD, Lee, KS, Green, MF (2005). Biosocial pathways to functional outcome in schizophrenia. Schizophrenia Research 80, 213–225.CrossRefGoogle ScholarPubMed
Brekke, JS, Levin, S, Wolkon, GH, Sobel, E, Slade, ES (1993). Psychosocial functioning and subjective experience in schizophrenia. Schizophrenia Bulletin 19, 599–608.CrossRefGoogle ScholarPubMed
Brekke, JS, Long, JD, Nesbitt, N, Sobel, E (1997 a). The impact of service characteristics on functional outcomes from community support programs for persons with schizophrenia: a growth curve analysis. Journal of Consulting and Clinical Psychology 65, 464–475.CrossRefGoogle ScholarPubMed
Brekke, JS, Nakagami, E (2010). The relevance of neurocognition and social cognition for outcome and recovery in schizophrenia. In Understanding and Treating Neuro- and Social Cognition in Schizophrenia (ed. Rodel, M. and Medalia, A.), pp. 23–36. Karger Publishers: Basel, Switzerland.Google Scholar
Brekke, JS, Raine, A, Ansel, M, Lencz, T, Bird, L (1997 b). Neuropsychological and psychophysiological correlates of psychosocial functioning in schizophrenia. Schizophrenia Bulletin 23, 19–28.CrossRefGoogle ScholarPubMed
Brothers, L (1990). The neural basis of primate social communication. Motivation and Emotion 14, 81–91.CrossRefGoogle Scholar
Brown, TA (2006). Confirmatory Factor Analysis for Applied Research. Guilford Press: New York.Google Scholar
Bruene, M (2005). Emotion recognition, ‘theory of mind’ and social behavior in schizophrenia. Psychiatry Research 133, 135–147.CrossRefGoogle Scholar
Cook, TD, Campbell, DT, Day, A (1979). Quasi-Experimentation: Design and Analysis Issues for Field Settings. Houghton Mifflin Company: Boston, MA.Google Scholar
Couture, SM, Penn, DL, Roberts, DL (2006). The functional significance of social cognition in schizophrenia: a review. Schizophrenia Bulletin 32 (Suppl. 1), S44–S63.CrossRefGoogle ScholarPubMed
Delis, DC, Kramer, JH, Kaplan, E, Ober, BA (1987). California Verbal Learning Test. The Psychological Corporation: Cleveland, OH.Google Scholar
Denis, D, Legerski, J (2006). Causal modeling and the origins of path analysis. Theory & Science 7.Google Scholar
Fett, AK, Viechtbauer, W, Dominguez, MD, Penn, DL, van Os, J, Krabbendam, L (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience and Biobehavioral Reviews 35, 573–588.CrossRefGoogle ScholarPubMed
Finkel, SE (1995). Causal Analysis with Panel Data. Sage Publications: Thousand Oaks, CA.CrossRefGoogle Scholar
Fiske, ST, Taylor, SE (1991). Social Cognition, 2nd edn. McGraw-Hill Book Company: New York.Google Scholar
Frith, CD (1992). The Cognitive Neuropsychology of Schizophrenia. Lawrence Erlbaum Associates: Hove, UK.Google Scholar
Geyer, MA, Tamminga, C (2004). MATRICS: measurement and treatment research to improve cognition in schizophrenia. Psychopharmacology 174, 1–162.CrossRefGoogle Scholar
Gollob, HF, Reichardt, CS (1991). Interpreting and estimating indirect effects assuming time lags really matter. In Best Methods for the Analysis of Change: Recent Advances, Unanswered Questions, Future Directions (ed. Collins, L. M. and Horn, J. L.), pp. 243–259. American Psychological Association: Washington, DC.CrossRefGoogle Scholar
Goodman, SH, Sewell, DR, Cooley, EL, Leavitt, N (1993). Assessing levels of adaptive functioning: the Role Functioning Scale. Community Mental Health Journal 29, 119–131.CrossRefGoogle ScholarPubMed
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321–330.Google ScholarPubMed
Green, MF, Kern, RS, Braff, DL, Mintz, J (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophrenia Bulletin 26, 119–136.CrossRefGoogle ScholarPubMed
Green, MF, Nuechterlein, KH (1999 a). Should schizophrenia be treated as a neurocognitive disorder? Schizophrenia Bulletin 25, 309–319.CrossRefGoogle ScholarPubMed
Green, MF, Nuechterlein, KH (1999 b). Backward masking performance as an indicator of vulnerability to schizophrenia. Acta Psychiatrica Scandinavica 99, 34–40.CrossRefGoogle Scholar
Green, MF, Nuechterlein, KH, Gold, JM, Barch, DM, Cohen, J, Essock, S, Fenton, WS, Frese, F, Goldberg, TE, Heaton, RK, Keefe, RSE, Kern, RS, Kraemer, H, Stover, E, Weinberger, DR, Zalcman, S, Marder, SR (2004). Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria. Biological Psychiatry 56, 301–307.CrossRefGoogle ScholarPubMed
Green, MF, Penn, DL, Bentall, R, Carpenter, WT, Gaebel, W, Gur, RC, Kring, AM, Park, S, Silverstein, SM, Heinssen, R (2008). Social cognition in schizophrenia: an NIMH workshop on definitions, assessment, and research opportunities. Schizophrenia Bulletin 34, 1211–1220.CrossRefGoogle ScholarPubMed
Green, RS, Gracely, EJ (1987). Selecting a rating scale for evaluation services to the chronically mentally ill. Community Mental Health Journal 23, 91–101.CrossRefGoogle Scholar
Heaton, RK (1981). A Manual for the Wisconsin Card Sorting Task. Psychological Assessment Resources: Odessa, FL.Google Scholar
Hedlund, JL, Vidweg, BW (1980). The Brief Psychiatric Rating Scale (BPRS): a comprehensive review. Journal of Operational Psychiatry 11, 49–65.Google Scholar
Horan, WP, Kern, RS, Penn, DL, Green, MF (2008). Social cognition training for individuals with schizophrenia: emerging evidence. American Journal of Psychiatric Rehabilitation 11, 205–252.CrossRefGoogle Scholar
Kee, KS, Green, MF, Mintz, J, Brekke, JS (2003). Is emotion processing a predictor of functional outcome in schizophrenia? Schizophrenia Bulletin 29, 487–498.CrossRefGoogle ScholarPubMed
Kee, KS, Kern, RS, Green, MF (1998). Perception of emotion and neurocognitive functioning in schizophrenia: what's the link? Psychiatry Research 81, 57–65.CrossRefGoogle ScholarPubMed
Kenny, DA (1975). Cross-lagged panel correlation: a test for spuriousness. Psychological Bulletin 82, 887–903.CrossRefGoogle Scholar
Kern, RS, Glynn, SM, Horan, WP, Marder, SR (2009 a). Psychosocial treatments to promote functional recovery in schizophrenia. Schizophrenia Bulletin 35, 347–361.CrossRefGoogle ScholarPubMed
Kern, RS, Liberman, RP, Becker, DR, Drake, RE, Sugar, CA, Green, MF (2009 b). Errorless learning for training individuals with schizophrenia at a community mental health setting providing work experience. Schizophrenia Bulletin 35, 807–815.CrossRefGoogle Scholar
Kerr, SL, Neale, JM (1993). Emotion perception in schizophrenia: specific deficit or further evidence of generalized poor performance? Journal of Abnormal Psychology 102, 312–318.CrossRefGoogle ScholarPubMed
Kline, RB (2005). Principles and Practice of Structural Equation Modeling, 2nd edn. Guilford Press: New York.Google Scholar
Kohler, CG, Walker, JB, Martin, EA, Healey, KM, Moberg, PJ (2010). Facial emotion perception in schizophrenia: a meta-analytic review. Schizophrenia Bulletin 36, 1009–1019.CrossRefGoogle ScholarPubMed
Kunda, Z (1999). Social Cognition: Making Sense of People. MIT Press: Cambridge, MA.CrossRefGoogle Scholar
Lezak, MD (1995). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Long, JD, Brekke, JS (1999). Longitudinal factor structure of the Brief Psychiatric Rating Scale in schizophrenia. Psychological Assessment 11, 498–506.CrossRefGoogle Scholar
Lukoff, D, Nuechterlein, K, Ventura, J (1986). Manual for the expanded Brief Psychiatric Rating Scale. Schizophrenia Bulletin 12, 594–602.Google Scholar
MacCallum, RC, Austin, JT (2000). Applications of structural equation modeling in psychological research. Annual Review of Psychology 51, 201–226.CrossRefGoogle ScholarPubMed
McArdle, JJ (2001). A latent difference score approach to longitudinal dynamic structural analyses. In Structural Equation Modeling: Present and Future (ed. Cudeck, R., Toit, S. D. and Sorbom, D.), pp. 342–380. Scientific Software International: Lincolnwood, IL.Google Scholar
McArdle, JJ, Hamagami, F (2001). Latent difference score structural models for linear dynamic analyses with incomplete longitudinal data. In New Methods for the Analysis of Change: Decade of Behavior (ed. Collins, L. and Sayer, A.), pp. 139–175. American Psychological Association: Washington, DC.CrossRefGoogle Scholar
McGurk, SR, Mueser, KT, Pascaris, A (2005). Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophrenia Bulletin 31, 898–909.CrossRefGoogle ScholarPubMed
McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry 164, 1791–1802.CrossRefGoogle ScholarPubMed
McPheeters, HL (1984). Statewide mental health outcome evaluation: a perspective of two southern states. Community Mental Health Journal 20, 44–55.CrossRefGoogle ScholarPubMed
Meyer, MB, Kurtz, MM (2009). Elementary neurocognitive function, facial affect recognition and social-skills in schizophrenia. Schizophrenia Research 110, 173–179.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (2004). Mplus: Statistical Analysis with Latent Variables. User's Guide. Muthén & Muthén: Los Angeles, CA.Google Scholar
Nakagami, E, Hoe, M, Brekke, JS (2010). The prospective relationships among intrinsic motivation, neurocognition, and community functioning in schizophrenia. Schizophrenia Bulletin 36, 935–948.CrossRefGoogle ScholarPubMed
Newcomer, JW, Faustman, WO, Yeh, W, Csernansky, JG (1990). Distinguishing depression and negative symptoms in unmedicated patients with schizophrenia. Psychiatry Research 31, 243–250.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Asarnow, RF (1992). UCLA Continuous Performance Test, Version 4. University of California, Los Angeles: Los Angeles, CA.Google Scholar
Nuechterlein, KH, Barch, DM, Gold, JM, Goldberg, TE, Green, MF, Heaton, RK (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research 72, 29–39.CrossRefGoogle ScholarPubMed
Oltmanns, TF, Neale, JM (1975). Schizophrenic performance when distractors are present: attentional deficit or differential task difficulty? Journal of Abnormal Psychology 84, 205–209.CrossRefGoogle ScholarPubMed
Penn, DL, Ritchie, M, Francis, J, Combs, D, Martin, J (2002). Social perception in schizophrenia: the role of context. Psychiatry Research 109, 149–159.CrossRefGoogle ScholarPubMed
Pinkham, AE, Penn, DL (2006). Neurocognitive and social cognitive predictors of interpersonal skill in schizophrenia. Psychiatry Research 143, 167–178.CrossRefGoogle ScholarPubMed
Pinkham, AE, Penn, DL, Perkins, DO, Lieberman, J (2003). Implications for the neural basis of social cognition for the study of schizophrenia. American Journal of Psychiatry 160, 815–824.CrossRefGoogle Scholar
Rhoades, H, Overall, J (1988). The semi-structured BPRS interview and rating guide. Psychopharmacology Bulletin 24, 101–104.Google Scholar
Roder, V, Medalia, A (2010). Neurocognition and Social Cognition in Schizophrenia Patients: Basic Concepts and Treatment. S. Karger AG: Basel, Switzerland.CrossRefGoogle Scholar
Rosenthal, R, Rosnow, R (2008). Essentials of Behavioral Research: Methods and Data Analysis. McGraw-Hill: New York.Google Scholar
Scott, A (2004). Reductionism revisited. Journal of Consciousness Studies 11, 51–68.Google Scholar
Sergi, MJ, Green, MF (2002). Social perception and early visual processing in schizophrenia. Schizophrenia Research 59, 233–241.CrossRefGoogle Scholar
Sergi, MJ, Rassovsky, Y, Nuechterlein, K, Green, MF (2006). Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. American Journal of Psychiatry 163, 448–454.CrossRefGoogle ScholarPubMed
Sergi, MJ, Rassovsky, Y, Widmark, C, Reist, C, Erhart, S, Braff, DL, Marder, SR, Green, MF (2007). Social cognition in schizophrenia: relationships with neurocognition and negative symptoms. Schizophrenia Research 90, 316–324.CrossRefGoogle ScholarPubMed
Test, MA, Knoedler, WH, Allness, DJ, Burke, SS, Brown, RL, Wallisch, LS (1991). Long-term community care through an assertive continuous treatment team. In Schizophrenia Research (Advances in Neuropsychiatry and Psychopharmacology) (ed. Tamminga, C. A. and Schulz, S. C.), Vol. 1, pp. 239–246. Raven Press: New York.Google Scholar
Thiemann, S, Csernansky, JG, Berger, PA (1987). Rating scales in research: the case of negative symptoms. Psychiatry Research 20, 47–55.CrossRefGoogle ScholarPubMed
Toomey, R, Schuldberg, D, Corrigan, PW, Green, MF (2002). Nonverbal social perception and symptomatology in schizophrenia. Schizophrenia Research 53, 83–91.CrossRefGoogle ScholarPubMed
van Hooren, S, Versmissen, D, Janssen, I, Myin-Germeys, I, à Campo, J, Mengelers, R, van Os, J, Krabbendam, L (2008). Social cognition and neurocognition as independent domains in psychosis. Schizophrenia Research 103, 257–265.CrossRefGoogle ScholarPubMed
Vaskinn, A, Sundet, K, Friis, S, Simonsen, C, Birkenaes, AB, Jonsdottir, H, Ringen, PA, Andreassen, OA (2008). Emotion perception and learning potential: mediators between neurocognition and social problem-solving in schizophrenia? Journal of the International Neuropsychological Society 14, 279–288.CrossRefGoogle ScholarPubMed
Vaskinn, A, Sundet, K, Hultman, CM, Friis, S, Andreassen, OA (2009). Social problem-solving in high-functioning schizophrenia: specific deficits in sending skills. Psychiatry Research 165, 215–223.CrossRefGoogle ScholarPubMed
Vauth, R, Rusch, N, Wirtz, M, Corrigan, PW (2004). Does social cognition influence the relation between neurocognitive deficits and vocational functioning in schizophrenia? Psychiatry Research 128, 155–165.CrossRefGoogle ScholarPubMed
Ventura, J, Green, MF, Shaner, A, Liberman, RP (1995). Training and quality assurance with the Brief Psychiatric Rating Scale: the drift busters. International Journal of Methods in Psychiatric Research 3, 221–244.Google Scholar
Waltheter, EJ, Jones, NT, Johnson, ER, Penn, DL (2005). Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness. Journal of Nervous and Mental Disease 193, 609–618.CrossRefGoogle Scholar
Young, AS, Sullivan, G, Murata, D, Sturm, D, Koegel, P (1998). Implementing publicly funded risk contracts with community mental health organizations. Psychiatric Services 49, 1579–1584.CrossRefGoogle ScholarPubMed