The Most Commonly Used Instruments in Research on Functioning in Schizophrenia
What Are They Measuring?
Abstract
Abstract. A comprehensive assessment of functioning in schizophrenia is essential to plan appropriate interventions for helping individuals with this health condition. The International Classification of Functioning, Disability and Health (ICF) offers a theoretical framework for assessing functioning and disability. Our aim was to identify the most frequently used measurement instruments reported in studies on functioning in schizophrenia, to conduct a content comparison with respect to the ICF, and to compare the categories extracted from these instruments with those covered by the Brief ICF-Core Set for schizophrenia. A structured literature search of studies on functioning in schizophrenia was conducted using Medline, CINAHL, and PsycINFO. The items of the top 20 measurement instruments were then linked to the ICF classification system. The most commonly used instruments were neuropsychological tests (i.e., Wisconsin Card Sorting Test and Trail Making Test) and measures of clinical symptoms (i.e., PANSS) and general functioning (i.e., GAF). The linking process resulted in 45 ICF categories (25 from Body functions, 1 from Body structures, 14 from Activities and Participation, and 5 from the Environmental factors component). Most of the top 20 instruments are not specifically designed for patients with schizophrenia or for assessing functioning, but rather are general standardized tests widely used to measure a broad range of outcome variables in several health conditions. Our results suggest a lack of an internationally accepted, commonly used, specific and comprehensive gold standard to assess functioning in individuals with schizophrenia.
References Documents marked with an asterisk correspond to instruments cited in Table 1.
2010). Global Assessment of Functioning (GAF): Properties and frontier of current knowledge. Annals of General Psychiatry, 9, 20. https://doi.org/10.1186/1744-859X-9-20
(*1990). A depression rating scale for schizophrenics. Schizophrenia Research, 3, 247–251. [Calgary Depression Scale]. https://doi.org/10.1016/0920-9964(90)90005-R
(2013). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.
. (2014). Neurocognitive Functioning of Individuals with Schizophrenia: Using and not using drugs. Schizophrenia Bulletin, 40, 856–867. https://doi.org/10.1093/schbul/sbt099
(2017). Exploring functioning in schizophrenia: Predictors of functional capacity and real-world behaviour. Psychiatry Research, 251, 118–124. https://doi.org/10.1016/j.psychres.2017.02.019
(*1996). BDI-II, Beck Depression Inventory: Manual. San Antonio, TX: Psychological Corporation.
(*1983). Multilingual aplasia examination (2nd ed.). [Controlled Oral Word Association Test]. Iowa City, IA: AJA Associates.
(2008). Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biological Psychiatry, 63, 505–511. https://doi.org/10.1016/j.biopsych.2007.05.022
(2011). The importance of measuring psychosocial functioning in schizophrenia. Annals of General Psychiatry, 10, 18. https://doi.org/10.1186/1744-859X-10-18
(2017). A systematic review of clinician-rated instruments to assess adults’ levels of functioning in specialised public sector mental health services. Australian & New Zealand Journal of Psychiatry, 51, 338–354. https://doi.org/10.1177/0004867416688098
(2018). Social cognitive dysfunction as a clinical marker: A systematic review of meta-analyses across 30 clinical conditions. Neuroscience & Biobehavioral Reviews, 84, 92–99. https://doi.org/10.1016/j.neubiorev.2017.11.014
(2002). Linking health-status measurements to the international classification of functioning, disability and health. Journal of Rehabilitation Medicine, 34, 205–210. https://doi.org/10.1080/165019702760279189
(2016). Refinements of the ICF linking rules to strengthen their potential for establishing comparability of health information. Disability and Rehabilitation, 17, 1–10. https://doi.org/10.3109/09638288.2016.1145258
(2005). ICF linking rules: An update based on lessons learned. Journal of Rehabilitation Medicine, 37, 212–218. https://doi.org/10.1080/16501970510040263
(*2000). The Conners’ Continuous Performance Test II user’s manual. Toronto, Canada: Multi-Health Systems.
(2007). Recovery from vs recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. Journal of Mental Health, 16, 459–470. https://doi.org/10.1080/09638230701482394
(*2000). California Verbal Learning Test – Second Edition (CVLT-II). San Antonio, TX: Pearson.
(2018). Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health. European Psychologist, 23, 167–187. https://doi.org/10.1027/1016-9040/a000318
(2014). The influence of illness-related variables, personal resources, and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry, 13, 275–287. https://doi.org/10.1002/wps.20167
. (2018). Interplay among psychopathologic variables, personal resources, context-related factors, and real-life functioning in individuals with schizophrenia a network analysis. JAMA Psychiatry, 75, 396–404. https://doi.org/10.1001/jamapsychiatry.2017.4607
. (2018). Beyond diagnosis: The core sets for persons with schizophrenia based on the world health organization’s international classification of functioning, disability, and health. Disability and Rehabilitation, 40, 2756–2766. https://doi.org/10.1080/09638288.2017.1356384
(2017). Functioning in patients with schizophrenia: a systematic review of the literature using the International Classification of Functioning, Disability and Health (ICF) as a reference. Quality of Life Research, 26, 531–543. https://doi.org/10.1007/s11136-016-1488-y
(2014). Cognition in schizophrenia: Past, present, and future. Schizophrenia Research: Cognition, 1, e1–e9. https://doi.org/10.1016/j.scog.2014.02.001
(2012). Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138, 240–247. https://doi.org/10.1016/j.schres.2012.03.031
(*Guy, W. (Ed.). (1976). ECDEU assessment manual for psychopharmacology, revised [Abnormal Involuntary Movement Scale and Clinical Global Impression]. Rockville, MD: National Institute of Mental Health
2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7, 141–168. https://doi.org/10.1146/annurev-clinpsy-032210-104449
(*1993). Wisconsin Card Sorting Test Manual: Revised and expanded. Odessa, FL: Psychological Assessment Resources.
(2013). The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: The mediating role of self-efficacy. Psychiatry Research, 206, 151–157. https://doi.org/10.1016/j.psychres.2012.09.056
(2003). Review: Lifetime prevalence of schizophrenia and related disorders is about 5.5 per 1000, but there is significant variation between regions. Evidence-Based Mental Health, 6, 74. https://doi.org/10.1136/ebmh.6.3.74
(*1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.
(2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. The British Journal of Psychiatry, 199, 445–452. https://doi.org/10.1192/bjp.bp.110.083733
(2017). Recovery and serious mental illness: A review of current clinical and research paradigms and future directions. Expert Review of Neurotherapeutics, 17, 1117–1130. https://doi.org/10.1080/14737175.2017.1378099
(2018). Revisiting the persistent negative symptoms proxy score using the Clinical Assessment Interview for Negative Symptoms. Schizophrenia Research, 202, 248–253. https://doi.org/10.1016/j.schres.2018.07.005
(*1962). Clinician’s judgments of mental health. Archives of General Psychiatry, 7, 407–417. [Global Assessment of Functioning]. https://doi.org/10.1001/archpsyc.1962.01720060019002
(2006). Special section: A memorial tribute: Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia. Psychiatric Services, 57, 1784–1791. https://doi.org/10.1176/ps.2006.57.12.1784
(2017). Contextual cognitive-behavioral therapies across the psychosis continuum: A review of evidence for schizophrenia, schizoaffective and bipolar disorders. European Psychologist, 22, 83–100. https://doi.org/10.1027/1016-9040/a000283
(2004). Schizophrenia and employment. Social Psychiatry and Psychiatric Epidemiology, 39, 337–349. https://doi.org/10.1007/s00127-004-0762-4
(2017). Rehabilitation interventions to promote recovery from schizophrenia: A systematic review. Frontiers in Psychiatry, 8, 100. https://doi.org/10.3389/fpsyt.2017.00100
(*1991). National Adult Reading Test (NART). Windsor, UK: NFER-Nelson.
(*1971). The assessment and analysis of handedness: The Edinburgh inventory. Neuropsychologia, 9, 97–113. https://doi.org/10.1016/0028-3932(71)90067-4
(*1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812. https://doi.org/10.2466/PR0.10.3.799-812
(2009). Reliability, validity and ability to detect change of the clinician-rated Personal and Social Performance scale in patients with acute symptoms of schizophrenia. Current Medical Research and Opinion, 25, 325–338. https://doi.org/10.1185/03007990802611919
(2018). Revised manual for the Global Assessment of Functioning scale. European Psychiatry, 51, 16–19. https://doi.org/10.1016/j.eurpsy.2017.12.028
(2014). Cognition, function, and disability in patients with schizophrenia: A review of longitudinal studies. The Canadian Journal of Psychiatry, 59, 13–17. https://doi.org/10.1177/070674371405900104
(*1958). Validity of the trail making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276. https://doi.org/10.2466/pms.1958.8.3.271
(*2006). Wide Range Achievement Test, Fourth Edition (WRAT-4). Oxford, UK: Pearson Assessment.
(2011). The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophrenia Research, 131, 133–138. https://doi.org/10.1016/j.schres.2011.05.023
(*1996). Rey Auditory and Verbal Learning Test. A handbook. Los Angeles, CA: Western Psychological Association.
(2016). Continued versus discontinued cannabis use in patients with psychosis: A systematic review and meta-analysis. The Lancet Psychiatry, 3, 215–225. https://doi.org/10.1016/S2215-0366(15)00363-6
(2015). A guide on how to develop an International Classification of Functioning, Disability and Health Core Set. European Journal of Physical and Rehabilitation Medicine, 51, 105–117.
(2008). A scientific agenda for the concept of recovery as it applies to schizophrenia. Clinical Psychology Review, 28, 1108–1124. https://doi.org/10.1016/j.cpr.2008.03.004
(*1970). A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica, 45, 11–19. https://doi.org/10.1111/j.1600-0447.1970.tb02066.x
(*1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662. https://doi.org/10.1037/h0054651
(2010). Developing the World Health Organization Disability Assessment Schedule 2.0. Bulletin of the World Health Organization, 88, 815–823.
(2009). Stigmatization as an environmental risk in schizophrenia: a user perspective. Schizophrenia Bulletin, 35, 293–296. https://doi.org/10.1093/schbul/sbn184
(2007). Are GAF scores reliable in routine clinical use? Acta Psychiatrica Scandinavica, 115, 326–330. https://doi.org/10.1111/j.1600-0447.2006.00925.x
(*2008). Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV). San Antonio, TX: The Psychological Corporation.
(*2009). Wechsler Memory Scale – Fourth Edition (WMS-IV). San Antonio, TX: Pearson.
(2001). International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: WHO.
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