This collaborative study (the P.I. of whose companion application is Dr. Philip D. Harvey) aims to validate assessments of real-world (RW) functional outcomes in people with schizophrenia. Schizophrenia patients are often impaired in their social and occupational functioning, their self-care, and their ability to live independently. Not only do these impairments worsen the patient's quality of life, they also increase the societal cost of his or her illness. While these impairments are evident in most patients, surprisingly little attention has been paid to the validity of assessments of these outcomes. Since the current tool of choice in predicting functional disability in schizophrenia is neuropsychological (NP) testing, proposals to reduce disability have tended to focus on short-term treatment of cognitive impairments. However, such trials are not well suited either to induce or identify improvements in real-world functioning. Some researchers have proposed switching to measures of functional capacity instead, but recent evidence suggests that the correlations obtained between functional-capacity measures, NP test results, and real-world outcomes are largely a function of the real-world rating scale that is used. Thus systematic studies are needed to determine the optimal means for measuring real-world disability and its response to treatment. The present proposal has three distinct goals.
It aims to determine: (1) the most accurate and practical scale for rating real-world outcomes in schizophrenia;(2) the optimal user of the scale;and (3) the factors that may impair the validity of self-reports of real-world outcomes on the part of schizophrenia patients. We adopt a construct-validation approach, using NP testing and functional-capacity measures as indicators of the construct and examining the convergence of various real-world outcome measures with these two indicators. Sophisticated data analysis will be performed to determine the convergences, and retesting will be performed to determine the test-retest stability of the candidate measures. The overall goal is to identify improved strategies for measuring real-world disability in schizophrenia and to inform the coming generation of treatment trials aimed at cognitive and functional enhancement through pharmacology and cognitive remediation in terms of the most suitable outcomes measures.
|Vella, Lea; Patterson, Thomas L; Harvey, Philip D et al. (2017) Exploratory analysis of normative performance on the UCSD Performance-Based Skills Assessment-Brief. Psychiatry Res 256:150-155|
|Obermeit, Lisa C; Beltran, Jessica; Casaletto, Kaitlin B et al. (2017) Evaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining ""symptomatic"" versus ""asymptomatic"" HAND. J Neurovirol 23:67-78|
|Burton, Cynthia Z; Harvey, Philip D; Patterson, Thomas L et al. (2016) Neurocognitive insight and objective cognitive functioning in schizophrenia. Schizophr Res 171:131-6|
|Ma, Qing; Vaida, Florin; Wong, Jenna et al. (2016) Long-term efavirenz use is associated with worse neurocognitive functioning in HIV-infected patients. J Neurovirol 22:170-8|
|Fazeli, Pariya L; Moore, David J; Franklin, Donald R et al. (2016) Lower CSF A? is Associated with HAND in HIV-Infected Adults with a Family History of Dementia. Curr HIV Res 14:324-30|
|Depp, C A; Bowie, C R; Mausbach, B T et al. (2015) Current smoking is associated with worse cognitive and adaptive functioning in serious mental illness. Acta Psychiatr Scand 131:333-41|
|Durand, Dante; Strassnig, Martin; Sabbag, Samir et al. (2015) Factors influencing self-assessment of cognition and functioning in schizophrenia: implications for treatment studies. Eur Neuropsychopharmacol 25:185-91|
|Gould, Felicia; McGuire, Laura Stone; Durand, Dante et al. (2015) Self-assessment in schizophrenia: Accuracy of evaluation of cognition and everyday functioning. Neuropsychology 29:675-82|
|Robertson, Belinda R; Prestia, Davide; Twamley, Elizabeth W et al. (2014) Social competence versus negative symptoms as predictors of real world social functioning in schizophrenia. Schizophr Res 160:136-41|
|Heaton, Robert K; Akshoomoff, Natacha; Tulsky, David et al. (2014) Reliability and validity of composite scores from the NIH Toolbox Cognition Battery in adults. J Int Neuropsychol Soc 20:588-98|
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