Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-24T21:49:09.513Z Has data issue: false hasContentIssue false
  • English
  • Français

From neurocognition to community participation in serious mental illness: the intermediary role of dysfunctional attitudes and motivation

Published online by Cambridge University Press:  25 November 2016

E. C. Thomas ,
L. Luther ,
L. Zullo ,
A. T. Beck  and
P. M. Grant
E. C. Thomas
Affiliation:
Department of Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
L. Luther
Affiliation:
Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
L. Zullo
Affiliation:
Department of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, USA
A. T. Beck
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
P. M. Grant*
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
*
*Address for correspondence: P. M. Grant, Ph.D., Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 2032, Philadelphia, PA, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Evidence for a relationship between neurocognition and functional outcome in important areas of community living is robust in serious mental illness research. Dysfunctional attitudes (defeatist performance beliefs and asocial beliefs) have been identified as intervening variables in this causal chain. This study seeks to expand upon previous research by longitudinally testing the link between neurocognition and community participation (i.e. time in community-based activity) through dysfunctional attitudes and motivation.

Method

Adult outpatients with serious mental illness (N = 175) participated, completing follow-up assessments approximately 6 months after initial assessment. Path analysis tested relationships between baseline neurocognition, emotion perception, functional skills, dysfunctional attitudes, motivation, and outcome (i.e. community participation) at baseline and follow-up.

Results

Path models demonstrated two pathways to community participation. The first linked neurocognition and community participation through functional skills, defeatist performance beliefs, and motivation. A second pathway linked asocial beliefs and community participation, via a direct path passing through motivation. Model fit was excellent for models predicting overall community participation at baseline and, importantly, at follow-up.

Conclusions

The existence of multiple pathways to community participation in a longitudinal model supports the utility of multi-modal interventions for serious mental illness (i.e. treatment packages that build upon individuals’ strengths while addressing the array of obstacles to recovery) that feature dysfunctional attitudes and motivation as treatment targets.

Keywords

Cognitive theorycommunity integrationpath analysisrecoveryschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 5 , April 2017 , pp. 822 - 836
Copyright
Copyright © Cambridge University Press 2016 

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, Girard, TA, Christensen, BK, Addington, D (2010). Social cognition mediates illness-related and cognitive influences on social function in patients with schizophrenia-spectrum disorders. Journal of Psychiatry & Neuroscience 35, 49–54.Google Scholar
Ahmed, AO, Murphy, CF, Latoussakis, V, McGovern, KE, English, J, Bloch, A, Anthony, DT, Savitz, AJ (2016). An examination of neurocognition and symptoms as predictors of post-hospital community tenure in treatment resistant schizophrenia. Psychiatry Research 236, 47–52.Google Scholar
Andreasen, NC (1982). Negative symptoms in schizophrenia: definition and reliability. Archives of General Psychiatry 39, 784–788.Google Scholar
Beck, AT, Rector, NA, Stolar, N, Grant, P (2009). Schizophrenia: Cognitive Theory, Research, and Therapy. Guilford Press: New York.Google Scholar
Birchwood, M, Smith, J, Cochrane, R, Wetton, S, Copestake, S (1990). The social functioning scale: the development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry 157, 853–859.Google Scholar
Bonner-Jackson, A, Grossman, LS, Harrow, M, Rosen, C (2010). Neurocognition in schizophrenia: a 20-year multi-follow-up of the course of processing speed and stored knowledge. Comprehensive Psychiatry 51, 471–479.Google Scholar
Bowie, CR, Reichenberg, A, Patterson, TL, Heaton, RK, Harvey, PD (2006). Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry 163, 418–425.Google Scholar
Brekke, J, Kay, DD, Lee, KS, Green, MF (2005). Biosocial pathways to functional outcome in schizophrenia. Schizophrenia Research 80, 213–225.Google Scholar
Brown, TA (2006). Confirmatory Factor Analysis for Applied Research. Guilford Press: New York.Google Scholar
Burns-Lynch, B, Brusilovskiy, E, Salzer, MS (in press). An empirical study of the relationship between community participation, recovery, and quality of life of individuals with serious mental illnesses. Israel Journal of Psychiatry.Google Scholar
Campellone, TR, Sanchez, AH, Kring, AM (in press). Defeatist performance beliefs, negative symptoms, and functional outcome in schizophrenia: a meta-analytic review. Schizophrenia Bulletin.Google Scholar
Carrión, RE, Goldberg, TE, McLaughlin, D, Auther, AM, Correll, CU, Cornblatt, BA (2011). Impact of neurocognition on social and role functioning in individuals at clinical high risk for psychosis. American Journal of Psychiatry 168, 806–813.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates: Hillsdale.Google Scholar
Choi, J, Choi, KH, Reddy, LF, Fiszdon, JM (2014). Measuring motivation in schizophrenia: is a general state of motivation necessary for task-specific motivation? Schizophrenia Research 153, 209–213.Google Scholar
Eckblad, ML, Chapman, LJ, Chapman, JP, Mishlove, M (1982). Revised Social Anhedonia Scale. University of Wisconsin: Madison.Google Scholar
Erwin, RJ, Gur, RC, Gur, RE, Skolnick, B, Mawhinney-Hee, M, Smailis, J (1992). Facial emotion discrimination: I. task construction and behavioural findings in normal subjects. Psychiatry Research 42, 231–240.Google Scholar
Fervaha, G, Zakzanis, KK, Foussias, G, Graff-Guerrero, A, Agid, O, Remington, G (2014). Motivational deficits and cognitive test performance in schizophrenia. JAMA Psychiatry 71, 1058–1065.Google Scholar
Galderisi, S, Rossi, A, Rocca, P, Bertolino, A, Mucci, A, Bucci, P, Rucci, P, Gibertoni, D, Aguglia, E, Amore, M, Bellomo, A, Biondi, M, Brugnoli, R, Dell'Osso, L, De Ronchi, D, Di Emidio, G, Di Giannantonio, M, Fagiolini, A, Marchesi, C, Monteleone, P, Oldani, L, Pinna, F, Roncone, R, Sacchetti, E, Santonastaso, P, Siracusano, A, Vita, A, Zeppegno, P, Maj, M (2014). The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 13, 275–287.Google Scholar
Gard, DE, Kring, AM, Gard, MG, Horan, WP, Green, MF (2007). Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophrenia Research 93, 253–260.CrossRefGoogle ScholarPubMed
Glahn, DC, Cannon, TD, Gur, RE, Ragland, JD, Gur, RC (2000). Working memory constrains abstraction in schizophrenia. Biological Psychiatry 47, 34–42.Google Scholar
Gold, J, Waltz, JA, Prentice, KJ, Morris, SE, Heerey, EA (2008). Reward processing in schizophrenia: a deficit in the representation of value. Schizophrenia Bulletin 34, 835–847.Google Scholar
Granholm, E, Ben-Zeev, D, Link, PC (2009). Social disinterest attitudes and group cognitive-behavioral social skills training for functional disability in schizophrenia. Schizophrenia Bulletin 35, 874–883.CrossRefGoogle ScholarPubMed
Granholm, E, Holden, J, Link, PC, McQuaid, JR (2014). Randomized clinical trial of cognitive behavioral social skills training for schizophrenia: improvement in functioning and experiential negative symptoms. Journal of Consulting and Clinical Psychology 82, 1173–1185.Google Scholar
Grant, PM, Beck, AT (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin 35, 798–806.Google Scholar
Grant, PM, Beck, AT (2010). Asocial beliefs as predictors of asocial behavior in schizophrenia. Psychiatry Research 177, 65–70.Google Scholar
Green, MF, Hellemann, G, Horan, WP, Lee, J, Wynn, JK (2012). From perception to functional outcome in schizophrenia: modeling the role of ability and motivation. Archives of General Psychiatry 69, 1216–1224.Google Scholar
Green, MF, Horan, WP, Barch, DM, Gold, JM (2015). Effort-based decision making: a novel approach for assessing motivation in schizophrenia. Schizophrenia Bulletin 41, 1035–1044.Google Scholar
Grant, PM, Huh, GA, Perivoliotis, D, Stolar, NM, Beck, AT (2012). Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Archives of General Psychiatry 69, 121–127.CrossRefGoogle 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.Google Scholar
Green, MF, Nuechterlein, KH (1999). Should schizophrenia be treated as a neurocognitive disorder? Schizophrenia Bulletin 25, 309–319.Google Scholar
Gur, RC, Jaggi, JL, Ragland, JD, Resnick, SM, Shtasel, D, Muenz, L, Gur, RE (1993). Effects of memory processing on regional brain activation: cerebral blood flow in normal subjects. International Journal of Neuroscience 72, 31–44.Google Scholar
Gur, RC, Ragland, JD, Moberg, PJ, Bilker, WB, Kohler, C, Siegel, SJ, Gur, RE (2001). Computerized neurocognitive scanning: II. The profile of schizophrenia. Neuropsychopharmacology 25, 777–788.Google Scholar
Gur, RE, Nimgaonkar, VL, Almasy, L, Calkins, ME, Ragland, JD, Pogue-Geile, MF, Kanes, S, Blangero, J, Gur, RC (2007). Neurocognitive endophenotypes in a multiplex multigenerational family study of schizophrenia. American Journal of Psychiatry 164, 813–819.Google Scholar
Harvey, PD, Velligan, DI, Bellack, AS (2007). Performance-based measures of functional skills: usefulness in clinical treatment studies. Schizophrenia Bulletin 33, 1138–1148.Google Scholar
Heiby, EM (1982). A self-reinforcement questionnaire. Behavior Research and Therapy 20, 397–401.Google Scholar
Horan, WP, Rassovsky, Y, Kern, RS, Lee, J, Wynn, JK, Green, M (2010). Further support for the role of dysfunctional attitudes in models of real-world functioning in schizophrenia. Journal of Psychiatric Research 44, 499–505.Google Scholar
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria v. new alternatives. Structural Equation Modeling 6, 1–55.Google Scholar
Kaplan, K, Salzer, MS, Brusilovskiy, E (2012). Community participation as a predictor of recovery-oriented outcomes among emerging and mature adults with mental illnesses. Psychiatric Rehabilitation Journal 35, 219–229.Google Scholar
Keefe, RSE (2014). Cognition and motivation as treatment targets in schizophrenia. JAMA Psychiatry 71, 987–988.Google Scholar
Kline, RB (2005). Principles and Practice of Structural Equation Modeling, 2nd edn. Guilford Press: New York.Google Scholar
Kohler, CG, Turner, TH, Bilker, WB, Brensinger, CM, Siegel, SJ, Kanes, SJ, Gur, RE, Gur, RC (2003). Facial emotion recognition in schizophrenia: intensity effects and error pattern. American Journal of Psychiatry 160, 1768–1774.Google Scholar
Kurtz, MM, Ragland, JD, Bilker, WB, Gur, RC, Gur, RE (2001). Comparison of continuous performance test with and without working memory demands in healthy controls and patients with schizophrenia. Schizophrenia Research 48, 307–316.Google Scholar
Kurtz, MM, Ragland, JD, Moberg, PJ, Gur, RC (2004). The penn conditional exclusion test: a new measure of executive function with alternate forms for repeat administration. Archives of Clinical Neuropsychology 19, 191–201.Google Scholar
Lepage, M, Bodnar, M, Bowie, CR (2014). Neurocognition: clinical and functional outcomes in schizophrenia. Canadian Journal of Psychiatry 59, 5–12.Google Scholar
Lin, C, Huang, C, Chang, Y, Chen, P, Lin, C, Tsai, GE, Lane, H (2013). Clinical symptoms, mainly negative symptoms, mediate the influence of neurocognition and social cognition on functional outcome of schizophrenia. Schizophrenia Research 146, 231–237.Google Scholar
Link, BG, Struening, EL, Neese-Todd, S, Asmussen, S, Phelan, JC (2001). Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services 52, 1621–1626.Google Scholar
Mausbach, BT, Harvey, PD, Goldman, SR, Jeste, DV, Patterson, TL (2007). Development of a brief scale of everyday functioning in persons with serious mental illness. Schizophrenia Bulletin 33, 1364–1372.Google Scholar
Meyer, MB, Kurtz, MM (2009). Elementary neurocognitive function, facial affect recognition and social-skills in schizophrenia. Schizophrenia Research 110, 173–179.Google Scholar
Muthén, LK, Muthén, BO (1998–2007). Mplus (version 5.1) [computer software and manual].Google Scholar
Nakagami, E, Xie, B, Hoe, M, Brekke, JS (2008). Intrinsic motivation, neurocognition and psychosocial functioning in schizophrenia: testing mediator and moderator effects. Schizophrenia Research 105, 95–104.Google Scholar
Nurnberger, JI, Blehar, MC, Kaufmann, CA, York-Cooler, C, Simpson, SG, Harkavy-Friedman, J, Severe, JB, Malaspina, D, Reich, T (1994). Diagnostic interview for genetic studies: rationale, unique features, and training. Archives of General Psychiatry 51, 849–859.Google Scholar
Quinlan, T, Roesch, S, Granholm, E (2014). The role of dysfunctional attitudes in models of negative symptoms and functioning in schizophrenia. Schizophrenia Research 157, 182–189.Google Scholar
Satorra, A, Bentler, PM (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika 66, 507–514.Google Scholar
Strassnig, MT, Raykov, T, O'Gorman, C, Bowie, CR, Sabbag, S, Durand, D, Patterson, TL, Pinkham, A, Penn, DL, Harvey, PD (2015). Determinants of different aspects of everyday outcome in schizophrenia: the roles of negative symptoms, cognition, and functional capacity. Schizophrenia Research 165, 76–82.Google Scholar
Strauss, GP, Morra, LF, Sullivan, SK, Gold, JM (2015). The role of low cognitive effort and negative symptoms in neuropsychological impairment in schizophrenia. Neuropsychology 29, 282–291.Google Scholar
Weissman, A (1978). The Dysfunctional Attitudes Scale: A Validation Study. University of Pennsylvania: Philadelphia.Google Scholar
WHO (2001). ICF: International Classification of Functioning, Disability, and Health. World Health Organization: Geneva, Switzerland.Google Scholar
Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry 168, 472–485.Google Scholar