Over the past several years, it has become increasingly apparent that prevention of the functional disability associated with schizophrenia is as important as the treatment of overt psychosis. In many patients with schizophrenia, disability in every day functioning is often profound and treatment resistant, limiting recovery regardless of how well psychosis is controlled with medication. Research in adults with chronic schizophrenia has indicated that neuropsychological dysfunction and negative symptoms are more directly related to functional outcome than are positive symptoms, and that function can be separated into capacity and real-world achievement (Green et al. 1996, 2000, 2004;Harvey et al. 2009). In the proposed method advancement project, we aim to develop a multi-dimensional functional battery specifically suited to young (adolescent to young adult) individuals in the prodromal or very early stages of psychosis. The battery will consist of five measures, two global interviews measuring social and role achievement and three self-report or computerized assessments measuring social/role capacity and emerging disability. The five measures are in various stages of development, with the two global interviews most extensively validated thus far (Auther et al. 2006;Cornblatt et al. 2007a;Cannon et al. 2008;see also Clinical Assessment Strategies Unit). The overall goals of the current project are to validate these measures in three ways, by assessing: 1) the extent to which these measures reflect "real world" functioning;2) whether these are sensitive to illness status;3) relationship to cognition. Following cross-sectional data collection as part of this project, an R01 is planned to prospectively investigate developmental trajectories in longitudinal data.
Specific aims for this project include: 1. To establish the psychometric properties of all five measures in the proposed test battery, including: a. Inter-rater reliability; b. Inter-relationships among the five tests to determine convergent validity and the extent to which a valid distinction can be made between functional achievement vs. capacity; c. Construct validity, i.e., the extent to which the measures reflect real world functioning based on information provided by parents, teachers and report cards; d. Age and gender norms for all measures. 2. To assess the sensitivity of the functional battery, i.e. the extent to which these measures systematically distinguish prodromal subjects from healthy controls. Once pre-illness deficits have been reliably demonstrated, the resulting final battery can be introduced into larger, future studies determining developmental course and predictive value of these assessments. 3. To evaluate the relationship between functional deficits and neurocognitive abnormality, as measured by the MATRICS battery (cf. Clinical Assessment Strategies Unit and Biomarkers Unit).
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