Are Social Cognition and Negative Symptoms Independently Associated With Level of Community Function

1
Are Social Cognition and Negative Symptoms
Independently Associated With Level of Community
Functioning in Schizophrenia?   William P.
Horan1, Mark J. Sergi2,3, Yuri Rassovsky1, Ute
Kreitz3, Mark McGee3, Michael F. Green1,3
  University of California, Los Angeles1
California State University, Northridge2, VA
Greater Los Angeles Healthcare System3
Results
Results (cont.)

• Introduction
• Schizophrenia is characterized by wide ranging
  functional impairments in the areas of
  independent living, vocational functioning, and
  social relationships.
• While basic neurocognitive deficits are important
  determinants of functional outcome (Green, 2001),
  it is clear that these disturbances do not fully
  account for the variance in functional outcome
  among patients.
• Functional impairments are also related to social
  cognitive deficits and certain negative symptoms
  (Milev et al., 2005 1998 Sergi et al., in
  press). Yet little is known about whether social
  cognition and negative symptoms are related to
  each other and whether they independently account
  for variance in community functioning.
• The identification of factors that independently
  contribute to poor outcome is critical for
  developing novel treatments to improve daily
  functioning.
• The current study used structural equation
  modeling to examine the relationships among
  negative symptoms, social cognition, and
  different types of functional outcome in a large
  sample of community dwelling schizophrenia
  outpatients

• Preliminary analyses Correlations among study
  variables

C. Best fitting model of relationships among
study variables

• Three research questions were addressed
• Do the negative symptoms assessed by the Schedule
  for the Assessment of Negative Symptoms (SANS)
  measure a unitary or a multifactorial latent
  construct?
• Do negative symptoms and social cognitive
  abilities tap distinct latent constructs?
• Are negative symptoms and social cognitive
  abilities independently associated with
  functional outcome?

• The SANS factors were not significantly
  associated with PONS total scores.
• PONS total scores and both SANS factors were
  independently (I.e., after controlling for the
  other predictors) associated with global
  functional outcome.
• SANS factor 2, comprised of the Avolition-apathy
  and Anhedonia-asociality subscales, was also
  uniquely associated with functional outcome in
  the area of social networks.

• Methods
• A. Subjects descriptive data
• 125 outpatients with schizophrenia as assessed
  by the Structured Clinical Interview for DSM-IV
  (First et
• al., 1996)
• All patients taking antipsychotic medications at
  clinically determined dosages
• Age M 43.5 years (SD 4.4)
• Sex 85 male
• Ethnicity 39 Caucasian, 39 African American
  12 Hispanic, 3 Asian Other.
• Education 12.5 years (SD 2.2).
• Duration of illness 19.6 years (SD 11.3)
• Patients had moderate levels of general
  psychiatric symptoms on Brief Psychiatric Rating
  Scale (Lukoff et
• al., 1986)
• Thought disturbance M 2.7 (SD 1.4)
• Anxiety/depression M 2.3 (SD 1.0)
• Anergia M 1.9 (SD .7)
• Hostility M 2.1 (SD .8)
• Activation M 1.3 (SD .5)

p lt .05 p lt 0.01

• Correlations among the SANS subscales ranged from
  .32 - .57.
• The SANS subscales minimally correlated with the
  PONS Total score.
• The SANS subscales and the PONS demonstrated a
  substantial range of correlation with the three
  functional outcome measures.

• Conclusions
• Consistent with previous factor analytic studies
  of the SANS (see Blanchard Cohen, in press),
  negative symptoms are best characterized by two
  latent factors. The first factor reflects
  disturbances in the expression of emotion and
  speech and the second factor reflects
  disturbances in emotional/motivational experience
  and social behavior.
• Negative symptoms and social cognitive abilities
  in the area of social perception reflect
  relatively independent constructs.
• Negative symptoms and social perception are
  independently associated with level of current
  functioning in the community.
• In addition, the second SANS factor was uniquely
  associated with quality of functioning in the
  area of social networks.
• Negative symptoms and social cognitive abilities
  are promising areas for future research aimed at
  identifying factors that contribute to different
  aspects of poor functional outcome. It will be
  important to determine whether these factors
  predict variance in outcome above and beyond
  basic neurocognitive deficits.

B. Best fitting model of SANS data

• B. Measures
• Negative symptoms
• Participants completed the Scale for the
  Assessment of Negative Symptoms (SANS Andreasen,
  1982)
• Affective flattening M 1.8 (SD 1.3)
• Alogia M .8 (SD 1.1)
• Avolition - apathy M 3.0 (SD 1.1)
• Anhedonia - asociality M 2.7 (SD 1.2)
• Social cognition
• Participants completed the first 110 scenes of
  the Profile of Nonverbal Sensitivity (PONS
  Rosenthal et al., 1979), which is referred to as
  the Half-PONS (Ambady et al., 1995).
• Scenes of this videotape-based measure last
  2-secs and contain facial expressions, voice
  intonations, and body gestures of a Caucasian
  female.
• After each scene, participants are asked to
  select from two labels (e.g., saying a prayer,
  talking to a lost child) the one that best
  describes the most likely context for the social
  cue(s).
• Possible score range 0 110
• M 77.6 (SD 7.8)
• Community functioning
• Assessments were conducted using the Community
  Adjustment Form (CAF Test et al., 1991 Brekke
  Aisley, 1995), a semi-structured interview that
  gathers data on 17 areas of community adjustment
  during the previous six months.

• References
• Andreasen, N. C. (1983). Scale for the Assessment
  of Negative Symptoms (SANS). Iowa City, IA
  University of Iowa.
• Blanchard, J.J., Cohen, A.S. (in press). The
  structure of negative symptoms within
  schizophrenia Implications for assessment.
  Schizophrenia Bulletin.
• Brekke, J.S., Long, J.D., Kay, D.D. (2002). The
  structure and invariance of a model of social
  functioning in schizophrenia. The Journal of
  Nervous and Mental Disease, 190, 63-72.
• Brekke, J.S., Aisley, R.A. (1995). Community
  Adjustment Form- Revised. Unpublished
  Instrument.Casciaro, T., Carley, KM., Krackhardt,
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• First, M.B., Gibbons, M., Spitzer, R.L.,
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• Green, M.F. (2001). Schizophrenia revealed From
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• Lukoff, D., Nuechterlein, K.H., Ventura, J.
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• Milev, P., Ho, B., Arndt, S., Andreasen, N. C.
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• A two factor model of the SANS provided a
  significantly better fit to the data than a one
  factor model
• Factor 1 consisted of the Affective flattening
  and Alogia subscales, which tap expressive
  aspects of emotion and speech
• Factor 2 consisted of the Avolition-Apathy and
  Anhedonia-Asociality subscales, which tap
  experiential aspects of social behavior