Daily activities, cognition and community functioning in persons with schizophrenia
Introduction
Independent living and related daily activities performance have been identified as treatment outcome priorities by persons with schizophrenia (Fischer et al., 2002). As well, independent living skills are major targets for rehabilitation interventions (American Psychiatric Association, 2004, Silverstein, 2000) and are associated to recovery (Liberman et al., 2002). Nevertheless, a great proportion of persons with schizophrenia still have chronic impairments leading to social and occupational difficulties as well as residential and financial dependence (Green and Nuechterlein, 1999, Häfner and an der Heiden, 1999, Rector and Beck, 2001) in spite of these current rehabilitation objectives.
Studies examining the relationship between functional capacity, i.e. the actual capacity to perform daily activities, and the broader domain of community functioning have reported mixed results. While a direct relationship between a person’s functional capacity and community living has been found in studies using performance-based assessments of daily living activities (Bowie et al., 2006, Keefe et al., 2006), other studies have reported no significant associations between the performance of specific daily tasks, and global scales of community functioning (Still, 2006).
More consistent findings have been found concerning the relationship of long-term memory, and working memory/executive function to community living and daily activities in people with schizophrenia (Green et al., 2000, Hoff and Kremen, 2003, Liddle, 2000).
Only a few studies have reported on the relationship between specific daily living activity performance and cognition in people with schizophrenia. The results of these studies acknowledge the relationship between long-term memory, selective and sustained attention, working memory/executive functioning and global aspects of daily task performance (Godbout et al., 2007, Greenwood et al., 2005, Rempfer et al., 2003, Semkovska et al., 2004). Some critical elements of the latter include: accuracy, sequencing and repetition of steps and degree of success in reaching the goal. But it is notable that none of these studies identify the specific problems and skills that are involved in the interaction between impaired cognitive abilities and “real-world functioning”, resulting in a decreased functional capacity.
Experts concerned with the development of effective interventions have called for studies exploring the relationship between daily functional capacity and community functioning (Bellack et al., 2007) as well as those between specific cognitive processes and specific functional tasks (McKibbin et al., 2004). Studies previously mentioned on the relationship between daily activities, community functioning and cognition in persons with schizophrenia present inconsistent findings and limited investigation of skill limitations. The present study aimed at filling in some of these gaps. First, this study aimed at exploring the relationship between daily activity performance, and specific cognitive functions, namely, attention, memory, and executive functions in persons with schizophrenia. Second, it aimed at examining the relationship between the performance of a daily activity and the community functioning of persons with a diagnostic of schizophrenia. More specifically, this study attempted to verify the following hypothesis: functional limitations observed during the performance of daily activities have a negative influence on community functioning in these persons. The relationship of symptoms with daily task performance was also explored, as these have also been found to be related to daily task performance (Godbout et al., 2007, Greenwood et al., 2005, Semkovska et al., 2004).
Section snippets
Participants
Two psychiatric outpatient clinics were used as recruitment centers in the Montreal, Quebec area and 82 persons with schizophrenia agreed to participate. Inclusion criteria included: a DSM-IV-TR (APA, 2000) diagnosis of schizophrenia or schizo-affective disorder confirmed by a treating psychiatrist, between 18 and 60 years of age, living in the community, familiar with meal preparation, able to speak French, and displaying a stable state without any major medication change for at least two
Participants
One person could not complete the Stroop test because of a color recognition problem, one did not complete the ESRS test and another one could not complete the working memory and planning tests. Since they had completed all the other tests, these persons were included in the study. The clinical characteristics of the participants (n = 82), are presented in Table 1. According to the CDS cut-offs (Muller et al., 2006) this group’s mean was below the cut-off for mild depression (≥ 3). Only 3 (3.6%)
Discussion
This study focused on the relationships between the actual performance of a daily task, cognitive deficits and community functioning in a group of people with schizophrenia. Similar to other studies, significant associations were found between functional capacity and memory, spatial working memory, planning and negative symptoms (Godbout et al., 2007, Greenwood et al., 2005, Rempfer et al., 2003). Specifically, only the associative visual memory and negative symptoms as well as years of
Conclusion
The present findings extend the previous ones concerning the relationship of functional capacity and cognitive tests as well as the association of functional capacity and community functioning in persons with schizophrenia. This study presents a unique perspective on the specific processing skills and strategies reflective of the underlying cognitive functions and relevant for efficient task performance and in turn for successful community living.
If rehabilitation interventions focus on
Role of the funding source
Funding for this study was provided by a grant from the Canadian Occupational Therapy Foundation (COTF) and from the Fonds de la Recherche en Santé du Québec (FRSQ). COTF and FRSQ had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Contributors
Ginette Aubin designed the study, wrote the protocol, managed the literature searches and analyses, the statistical analysis and wrote the first draft of this manuscript. All of this work was done under the guidance of Isabelle Gélinas, Ph.D., Emmanuel Stip, M.D., Constant Rainville, Ph.D. and Christine Chapparo, Ph.D. They offered practical suggestions and advice on the research methodology, design of the studies, data analysis, and interpretation. They are co-authors on this paper and
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
We thank Tania Pampoulova, Jocelyne Thérien and Kathe Villeneuve for their help in the organization of the data collection, as well as Sara Liebman for the editing of this paper.
References (48)
- et al.
Specificity of the Calgary Depression Scale for schizophrenics
Schizophr. Res.
(1994) - et al.
Manual for the Extrapyramidal Symptom Rating Scale (ESRS)
Schizophr. Res.
(2005) - et al.
Social functioning and neurocognitive deficits in outpatients with schizophrenia: a 2-year follow-up
Schizophr. Res.
(1999) - et al.
General and specific cognitive deficits in schizophrenia
Biol. Psychiatry
(2004) - et al.
Neuropsychological and activity of daily living script performance in patients with positive or negative schizophrenia
Compr. Psychiatry
(2007) - et al.
Computerized assessment of cognition in schizophrenia: promises and pitfalls of CANTAB
Eur. Psychiatr.
(2007) - et al.
Direct assessment of functional abilities: relevance to persons with schizophrenia
Schizophr. Res.
(2004) - et al.
CANTAB explicit memory is less impaired in addicted schizophrenia patients
Brain Cogn.
(2005) - et al.
Cognitive predictors of psychosocial functioning outcome in schizophrenia: a follow-up study of subjects participating in a rehabilitation program
Schizophr. Res.
(2005) - et al.
The relations between cognition and the independent living skill of shopping in people with schizophrenia
Psychiatry Res.
(2003)
Assessment of executive dysfunction during activities of daily living in schizophrenia
Schizophr. Res.
Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR
Practice Guidelines for the Treatment of Patients with Schizophrenia
A community ability scale for chronically mentally ill consumers: Part I. Reliability and validity
Community Ment. Health J.
Cognitive rehabilitation for schizophrenia: problems, prospects, and strategies
Schizophr. Bull.
Assessment of community functioning in people with schizophrenia and other severe mental illnesses: a white paper based on an NIMH-sponsored workshop
Schizophr. Bull.
Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms
Am. J. Psychiat.
Strategy application disorder: the role of the frontal lobes in human multitasking
Psychol. Res.
The PRPP System of Task Analysis: User’s Training Manual
Factor structure of the Multnomah Community Ability Scale
J. of Nerv. Ment. Dis.
Assessment of independent living skills for psychotic patients: further validity and reliability
J. of Nerv. Ment. Dis.
Priorities of consumers, providers, and family members in the treatment of schizophrenia
Psychiatr. Serv.
Mon expérience comme fiduciaire de patients psychiatriques
Sante Ment. Que.
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