Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-03T04:18:40.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Pathways between early visual processing and functional outcome in schizophrenia

Published online by Cambridge University Press:  19 May 2010

Y. Rassovsky ,
W. P. Horan ,
J. Lee ,
M. J. Sergi  and
M. F. Green
Y. Rassovsky*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
W. P. Horan
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
J. Lee
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
M. J. Sergi
Affiliation:
California State University, Northridge, CA, USA
M. F. Green
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
*
*Address for correspondence: Y. Rassovsky, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza (C8-746), Los Angeles, CA 90095, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Early visual processing deficits are reliably detected in schizophrenia and show relationships to poor real-world functioning. However, the nature of this relationship is complex. Theoretical models and recent studies using statistical modeling approaches suggest that multiple intervening factors are involved. We previously reported that a direct and significant association between visual processing and functional status was mediated by a measure of social perception. The present study examined the contribution of negative symptoms to this model.

Method

We employed structural equation modeling (sem) to test several models of outcome, using data from 174 schizophrenia out-patients. Specifically, we examined the direct and indirect relative contributions of early visual processing, social perception and negative symptoms to functional outcome.

Results

First, we found that, similar to social perception, a measure of negative symptoms mediated the association between visual information processing and functional status. Second, we found that the inclusion of negative symptoms substantially enhanced the explanatory power of the model. Notably, it was the experiential aspect of negative symptoms (avolition and anhedonia) more than the expressive aspect (affective flattening and alogia) that accounted for significant variance in functional outcome, especially in the social component of the construct of functional outcome.

Conclusions

Social perception and negative symptoms play relevant roles in functional impairment in schizophrenia. Both social perception and negative symptoms statistically mediate the connection between visual processing and functional outcome. However, given the lack of association between social perception and negative symptoms, these constructs appear to have an impact on functioning through separate pathways.

Keywords

Functional outcomeneurocognitionschizophreniasocial cognitionvisual masking
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 3 , March 2011 , pp. 487 - 497
Copyright
Copyright © Cambridge University Press 2010

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, McCleary, L, Munroe-Blum, H (1998). Relationship between cognitive and social dysfunction in schizophrenia. Schizophrenia Research 34, 59–66.CrossRefGoogle ScholarPubMed
Adolphs, R (2001). The neurobiology of social cognition. Current Opinion in Neurobiology 11, 231–239.CrossRefGoogle ScholarPubMed
Ambady, N, Hallahan, M, Rosenthal, R (1995). On judging and being judged accurately in zero-acquaintance situations. Journal of Personality and Social Psychology 69, 519–529.CrossRefGoogle Scholar
Andreasen, NC (1984). The Scale for the Assessment of Negative Symptoms (SANS). The University of Iowa: Iowa City, IA.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Press: Washington, DC.Google Scholar
Balogh, DW, Merritt, RD (1985). Susceptibility to type A backward pattern masking among hypothetically psychosis-prone college students. Journal of Abnormal Psychology 94, 377–383.CrossRefGoogle ScholarPubMed
Baron, RM, Kenny, DA (1986). The moderator mediator variable distinction in social psychological-research – conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.Google Scholar
Beck, AT, Rector, NA, Stolar, N, Grant, P (2009). Schizophrenia: Cognitive Theory, Research, and Therapy. The Guilford Press: New York.Google Scholar
Bentler, PM (1990). Comparative fit indexes in structural models. Psychological Bulletin 107, 238–246.CrossRefGoogle ScholarPubMed
Bentler, PM (1996). EQS: Structural Equations Program Model. BMDP Statistical Software: Los Angeles.Google Scholar
Blanchard, JJ, Cohen, AS (2006). The structure of negative symptoms within schizophrenia: implications for assessment. Schizophrenia Bulletin 32, 238–245.CrossRefGoogle ScholarPubMed
Bowie, CR, Leung, WW, Reichenberg, A, McClure, MM, Patterson, TL, Heaton, RK, Harvey, PD (2008). Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures. Biological Psychiatry 63, 505–511.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Braff, DL, Saccuzzo, DP, Geyer, MA (1991). Information processing dysfunctions in schizophrenia: studies of visual backward masking, sensorimotor gating, and habituation. In Neuropsychology, Psychophysiology, and Information Processing (ed. Steinhauer, S. R., Gruzelier, J. H. and Zubin, J.), pp. 303–334. Elsevier Science: New York.Google Scholar
Breier, A, Schreiber, JL, Dyer, J, Pickar, D (1991). National Institutes of Mental Health longitudinal study of chronic schizophrenia: prognosis and predictors of outcome. Archives of General Psychiatry 48, 239–246.CrossRefGoogle ScholarPubMed
Brekke, JS, Kay, DD, Kee, KS, Green, MF (2005). Biosocial pathways to functional outcome in schizophrenia. Schizophrenia Research 80, 213–225.CrossRefGoogle ScholarPubMed
Brill, N, Levine, SZ, Reichenberg, A, Lubin, G, Weiser, M, Rabinowitz, J (2009). Pathways to functional outcomes in schizophrenia: the role of premorbid functioning, negative symptoms and intelligence. Schizophrenia Research 110, 40–46.Google Scholar
Butler, PD, DeSanti, LA, Maddox, J, Harkavy-Friedman, JM, Amador, XF, Goetz, RR, Javitt, DC, Gorman, JM (2003). Visual backward-masking deficits in schizophrenia: relationship to visual pathway function and symptomatology. Schizophrenia Research 59, 199–209.CrossRefGoogle ScholarPubMed
Butler, PD, Silverstein, SM, Dakin, SC (2008). Visual perception and its impairment in schizophrenia. Biological Psychiatry 64, 40–47.CrossRefGoogle ScholarPubMed
Cadenhead, KS, Serper, Y, Braff, DL (1998). Transient versus sustained visual channels in the visual backward masking deficits of schizophrenia patients. Biological Psychiatry 43, 132–138.CrossRefGoogle ScholarPubMed
Fenton, WS, McGlashan, TH (1994). Antecedents, symptom progression, and long-term outcome of the deficit syndrome in schizophrenia. American Journal of Psychiatry 151, 351–356.Google ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition. New York State Psychiatric Institute: New York.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
Gold, JM (2004). Cognitive deficits as treatment targets in schizophrenia. Schizophrenia Research 72, 21–28.CrossRefGoogle ScholarPubMed
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
Grant, PM, Beck, AT (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin 35, 798–806.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, Kern, RS, Heaton, RK (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research 72, 41–51.CrossRefGoogle ScholarPubMed
Green, MF, Nuechterlein, KH, Breitmeyer, B (1997). Backward masking performance in unaffected siblings of schizophrenia patients: evidence for a vulnerability indicator. Archives of General Psychiatry 54, 465–472.CrossRefGoogle ScholarPubMed
Green, MF, Nuechterlein, KH, Breitmeyer, B (2002). Development of a computerized assessment for visual masking. International Journal of Methods in Psychiatric Research 11, 83–89.CrossRefGoogle ScholarPubMed
Green, MF, Nuechterlein, KH, Breitmeyer, B, Mintz, J (1999). Backward masking in unmedicated schizophrenic patients in psychotic remission: possible reflections of aberrant cortical oscillations. American Journal of Psychiatry 156, 1367–1373.Google Scholar
Green, MF, Nuechterlein, KH, Breitmeyer, B, Mintz, J (2006). Forward and backward visual masking in unaffected siblings of schizophrenic patients. Biological Psychiatry 59, 446–451.Google Scholar
Green, MF, Nuechterlein, KH, Breitmeyer, B, Tsuang, J, Mintz, J (2003). Forward and backward visual masking in schizophrenia: influence of age. Psychological Medicine 33, 887–895.Google Scholar
Green, MF, Nuechterlein, KH, Mintz, J (1994 a). Backward-masking in schizophrenia and mania. 1. Specifying a mechanism. Archives of General Psychiatry 51, 939–944.CrossRefGoogle Scholar
Green, MF, Nuechterlein, KH, Mintz, J (1994 b). Backward-masking in schizophrenia and mania. 2. Specifying the visual channels. Archives of General Psychiatry 51, 945–951.CrossRefGoogle ScholarPubMed
Green, MF, Walker, E (1986). Symptom correlates of vulnerability to backward masking in schizophrenia. American Journal of Psychiatry 143, 181–186.Google ScholarPubMed
Harvey, PD, Parrella, M, White, L, Mohs, RC, Davis, KL (1999). Convergence of cognitive and functional decline in poor outcome schizophrenia. Schizophrenia Research 35, 77–84.Google Scholar
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445.CrossRefGoogle ScholarPubMed
Horan, WP, Kring, AM, Blanchard, JJ (2006). Anhedonia in schizophrenia: a review of assessment strategies. Schizophrenia Bulletin 32, 259–273.CrossRefGoogle ScholarPubMed
Horan, WP, Rassovsky, Y, Kern, RS, Lee, J, Wynn, JK, Green, MF (in press). Further support for the role of dysfunctional attitudes in models of real-world functioning in schizophrenia. Journal of Psychiatric Research.Google Scholar
Hu, L-T, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 1–55.CrossRefGoogle Scholar
Jamshidian, M, Bentler, PM (1999). ML estimation of mean and covariance structures with missing data using complete data routines. Journal of Educational and Behavioral Statistics 24, 21–41.CrossRefGoogle Scholar
Javitt, DC (2009). When doors of perception close: bottom-up models of disrupted cognition in schizophrenia. Annual Review of Clinical Psychology 5, 249–275.CrossRefGoogle ScholarPubMed
Kee, KS, Green, MF, Mintz, J, Brekke, JS (2003). Is emotional processing a predictor of functional outcome in schizophrenia? Schizophrenia Bulletin 29, 487–497.CrossRefGoogle ScholarPubMed
Keri, S, Kelemen, O, Benedek, G, Janka, Z (2001). Different trait markers for schizophrenia and bipolar disorder: a neurocognitive approach. Psychological Medicine 31, 915–922.Google Scholar
Mackinnon, DP, Warsi, G, Dwyer, JH (1995). A simulation study of mediated effect measures. Multivariate Behavioral Research 30, 41–62.Google Scholar
McPheeters, HL (1984). Statewide mental-health outcome evaluation – a perspective of 2 southern states. Community Mental Health Journal 20, 44–55.CrossRefGoogle Scholar
Monti, PM, Fingeret, AL (1987). Social perception and communication skills among schizophrenics and nonschizophrenics. Journal of Clinical Psychology 43, 197–205.Google Scholar
Orsel, S, Akdemir, A, Dag, I (2004). The sensitivity of quality-of-life scale WHOQOL-100 to psychopathological measures in schizophrenia. Comprehensive Psychiatry 45, 57–61.Google Scholar
Overall, JE, Gorham, DR (1962). The Brief Psychiatric Rating Scale. Psychological Reports 10, 799–812.CrossRefGoogle Scholar
Penn, DL, Corrigan, PW, Bentall, RP, Racenstein, JM, Newman, L (1997). Social cognition in schizophrenia. Psychological Bulletin 121, 114–132.CrossRefGoogle ScholarPubMed
Pinkham, AE, Penn, DL, Perkins, DO, Lieberman, JA (2003). Implications of a neural basis for social cognition for the study of schizophrenia. American Journal of Psychiatry 160, 815–824.CrossRefGoogle Scholar
Rassovsky, Y, Green, MF, Nuechterlein, KH, Breitmeyer, B, Mintz, J (2004). Paracontrast and metacontrast in schizophrenia: clarifying the mechanism for visual masking deficits. Schizophrenia Research 71, 485–492.Google Scholar
Rassovsky, Y, Green, MF, Nuechterlein, KH, Breitmeyer, BG, Mintz, J (2005). Visual processing in schizophrenia: structural equation modeling of visual masking performance. Schizophrenia Research 78, 251–260.Google Scholar
Rector, NA, Beck, AT, Stolar, N (2005). The negative symptoms of schizophrenia: a cognitive perspective. Canadian Journal of Psychiatry 50, 247–257.Google Scholar
Rocca, P, Montemagni, C, Castagna, F, Giugiario, M, Scalese, M, Bogetto, F (2009). Relative contribution of antipsychotics, negative symptoms and executive functions to social functioning in stable schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry 33, 373–379.CrossRefGoogle ScholarPubMed
Rosenthal, R, Hall, JA, DiMatteo, MR, Rogers, PL, Archer, D (1979). Sensitivity to Nonverbal Communication: The PONS Test. Johns Hopkins University Press: Baltimore, MD.Google Scholar
Rund, BR (1993). Backward-masking performance in chronic and nonchronic schizophrenics, affectively disturbed patients, and normal control subjects. Journal of Abnormal Psychology 102, 74–81.Google Scholar
Saccuzzo, DP, Schubert, DL (1981). Backward masking as a measure of slow processing in schizophrenia spectrum disorders. Journal of Abnormal Psychology 90, 305–312.Google Scholar
Sayers, SL, Curran, PJ, Mueser, KT (1996). Factor structure and construct validity of the scale for the assessment of negative symptoms. Psychological Assessment 8, 269–280.Google Scholar
Schuck, JR, Lee, RG (1989). Backward masking, information processing, and schizophrenia. Schizophrenia Bulletin 15, 491–500.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, KH, 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.Google Scholar
Slaghuis, WL, Bakker, VJ (1995). Forward and backward visual masking of contour by light in positive and negative symptom schizophrenia. Journal of Abnormal Psychology 104, 41–54.CrossRefGoogle ScholarPubMed
Toomey, R, Schuldberg, D, Corrigan, PW, Green, MF (2002). Nonverbal social perception and symptomatology in schizophrenia. Schizophrenia Research 53, 83–91.Google Scholar
Ullman, JB (2001). Structural equation modeling. In Using Multivariate Statistics (ed. Tabachnick, B. G. and Fidell, L. S.), pp. 653–771. Allyn and Bacon: Boston, MA.Google Scholar
Wetherill, GB, Levitt, H (1965). Sequential estimation of points on a psychometric function. British Journal of Mathematical and Statistical Psychology 18, 1–10.Google Scholar