This collaborative study (the P.I. of whose companion application is Dr. Thomas Patterson) 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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH078775-05
Application #
8134258
Study Section
Special Emphasis Panel (ZRG1-BBBP-G (60))
Program Officer
Morris, Sarah E
Project Start
2007-09-25
Project End
2013-06-30
Budget Start
2011-07-01
Budget End
2013-06-30
Support Year
5
Fiscal Year
2011
Total Cost
$340,808
Indirect Cost
Name
University of Miami School of Medicine
Department
Psychiatry
Type
Schools of Medicine
DUNS #
052780918
City
Coral Gables
State
FL
Country
United States
Zip Code
33146
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
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
Strassnig, Martin T; Raykov, Tenko; O'Gorman, Cedric et al. (2015) Determinants of different aspects of everyday outcome in schizophrenia: The roles of negative symptoms, cognition, and functional capacity. Schizophr Res 165:76-82
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
Siu, Cynthia O; Harvey, Philip D; Agid, Ofer et al. (2015) Insight and subjective measures of quality of life in chronic schizophrenia. Schizophr Res Cogn 2:127-132
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
Sabbag, Samir; Prestia, Davide; Robertson, Belinda et al. (2015) Absence of bias in clinician ratings of everyday functioning among African American, Hispanic and Caucasian patients with schizophrenia. Psychiatry Res 229:347-52
Harvey, Philip D; Paschall, Gayla; Depp, Colin (2015) Factors influencing self-assessment of cognition and functioning in bipolar disorder: a preliminary study. Cogn Neuropsychiatry 20:361-71
Vargas, Gabriela; Strassnig, Martin; Sabbag, Samir et al. (2014) The course of vocational functioning in patients with schizophrenia: Re-examining social drift. Schizophr Res Cogn 1:e41-e46

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