Schizophrenia and schizoaffective disorder (SZ/SA) are among the 10 most disabling of all medical conditions worldwide. In 1997 this investigator was awarded an R01 to study how neuropsychological (NP) deficits are associated with independent life function (LF) over an 18 month period following an acute exacerbation of illness and extending into the process of recovery and reintegration into the community. Preliminary data from the first 143 subjects (out of 200 enrolled to date) reveal a significant association between NP deficits and LF. More importantly, data show 1) a highly significant gender by NP interaction in which different patterns of cognitive deficit are associated with disability in males versus females and 2) an interaction between negative symptoms and NP whereby selected cognitive measures are associated with LF only when patients have less severe negative symptoms. To the best of our knowledge these interactions are original, previously unreported findings. On the basis of these findings, the present study is proposed to determine which cognitive operations, in combination with negative symptoms, are associated with disability in males vs females having SZ/SA. The present cohort is followed for an additional 18 months to capture more fully LF recovery and combined with a new cohort of 250 subjects to afford sufficient statistical power to investigate these interactions. Comprehensive Assessments of NP, LF and clinical symptoms are conducted at baseline (following hospital discharge) and 6, 18 and 36 months thereafter. Disability and Service Use are tracked monthly. The study design is further enhanced with the addition of Comprehensive Assessments that are """"""""triggered"""""""" by the occurrence of significant improvements in level of LF. This procedure will enable us to determine whether and how changes in level of LF are associated with contemporaneous changes in cognitive performance and negative symptoms in each gender group. The differentiation of episodic vs. enduring cognitive barriers is important for deciding between remedial and supportive interventions and will further the practical intent of our investigations: to determine how best to target rehabilitation and supports and optimize recovery of community roles for the individual.
