Leifker Feea R, Bowie Christopher R, Harvey Philip D
Emory University School of Medicine, Atlanta, GA 30322, USA.
Schizophr Res. 2009 Nov;115(1):82-7. doi: 10.1016/j.schres.2009.09.004. Epub 2009 Sep 22.
Deficits in everyday living skills and social skills are associated with the pervasive disability seen in schizophrenia. Cognitive impairments are determinants of these skills deficits and it is known that positive and negative symptoms add to the influence of cognitive impairments for prediction of real-world outcomes. This study examined the relative importance of cognitive impairments measured with a neuropsychological battery, performance-based measures of social and everyday living skills, and positive and negative symptoms for the prediction of real-world outcomes in social and residential domains. In contrast to most previous studies, we examined the importance of individual symptoms, as well as total subscale scores, for predicting clinician rated outcomes in 194 older outpatients with schizophrenia. Symptoms were rated with the Positive and Negative Syndrome Scale; everyday living skills were measured by the UCSD Performance-based Skills Assessment; and social skills were measured with the Social Skills Performance Assessment. For prediction of real-world social outcomes, blunted affect and passive-apathetic social withdrawal accounted for all of the predicted variance, while social competence and cognitive impairments did not enter the final equation. For residential functioning, everyday living skills were the most important predictor, followed by lack of spontaneity. The positive symptoms of hallucinatory behavior and suspiciousness also predicted real-world residential outcomes. These results suggest that real-world disability is the product of a complex array of ability deficits and symptoms, indicating interventions will need to be carefully targeted. For social and everyday living outcomes, variance accounted for by the entire array of predictive variables was less than 40%, suggesting that other factors, such as social and cultural influences, are involved as well.
日常生活技能和社交技能的缺陷与精神分裂症中普遍存在的残疾有关。认知障碍是这些技能缺陷的决定因素，并且已知阳性和阴性症状会增加认知障碍对预测现实世界结果的影响。本研究考察了用神经心理测验组合测量的认知障碍、基于表现的社交和日常生活技能测量以及阳性和阴性症状对于预测社交和居住领域现实世界结果的相对重要性。与大多数先前的研究不同，我们考察了个体症状以及总分量表得分对于预测194名老年精神分裂症门诊患者临床医生评定结果的重要性。症状用阳性和阴性症状量表进行评定；日常生活技能通过加州大学圣地亚哥分校基于表现的技能评估进行测量；社交技能通过社交技能表现评估进行测量。对于预测现实世界的社交结果，情感迟钝和被动冷漠的社交退缩解释了所有预测方差，而社交能力和认知障碍未进入最终方程。对于居住功能，日常生活技能是最重要的预测因素，其次是缺乏自发性。幻觉行为和猜疑等阳性症状也预测了现实世界的居住结果。这些结果表明，现实世界中的残疾是一系列复杂的能力缺陷和症状的产物，这表明干预措施需要谨慎地针对性实施。对于社交和日常生活结果，所有预测变量解释的方差不到40%，这表明其他因素，如社会和文化影响，也参与其中。
