Daily activities, cognition and community functioning in persons with schizophrenia

doi:10.1016/j.schres.2008.08.002

Schizophrenia Research

Volume 107, Issues 2–3, February 2009, Pages 313-318

https://doi.org/10.1016/j.schres.2008.08.002 Get rights and content

Abstract

Objective

This cross-sectional study explored the relationships between daily activity performance, attention, memory, executive functions and community functioning in people with schizophrenia. More specifically, this study attempted to verify the hypothesis that functional limitations in the performance of daily activities negatively affect community functioning in people with schizophrenia.

Methods

Eighty-two individuals with schizophrenia living in the community were recruited for the study. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis was used to assess participants’ functional capacity during a meal preparation task. Visuo-spatial associative memory, spatial working memory, planning, visuo-motor coordination, and selective attention were evaluated as well. Community functioning was assessed with the Independent Living Skills Survey (ILSS) and the Multnomah Community Ability Scale (MCAS).

Results

Correlations revealed significant associations between functional capacity and visuo-spatial associative learning, spatial working memory, planning and negative symptoms. Planning skills during meal preparation were found to be associated with MCAS. After regression analyses, only visuo-spatial memory, negative symptoms, education and familiarity with meal preparation explained variation in functional capacity.

Conclusions

The findings of the current study suggest that visuo-spatial associative learning, negative symptoms, education and familiarity with task are among the important factors for functional capacity. Planning skills necessary for efficient task performance were also found to be those most determinant for community functioning. Rehabilitation interventions should consider these underlying strength and deficits when developing strategies to help people with schizophrenia build functional skills essential for community living.

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.

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Daily activities, cognition and community functioning in persons with schizophrenia

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Participants

Participants

Discussion

Conclusion

Role of the funding source

Contributors

Conflict of interest

Acknowledgments

Schizophr. Res.

Schizophr. Res.

Schizophr. Res.

Biol. Psychiatry

Compr. Psychiatry

Eur. Psychiatr.

Schizophr. Res.

Brain Cogn.

Schizophr. Res.

Psychiatry Res.

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.