University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
Schizophr Bull. 2011 Sep;37 Suppl 2(Suppl 2):S41-54. doi: 10.1093/schbul/sbr079.
Cognitive impairments are currently regarded as important determinants of functional domains and are promising treatment goals in schizophrenia. Nevertheless, the exact nature of the interdependent relationship between neurocognition and social cognition as well as the relative contribution of each of these factors to adequate functioning remains unclear. The purpose of this article is to systematically review the findings and methodology of studies that have investigated social cognition as a mediator variable between neurocognitive performance and functional outcome in schizophrenia. Moreover, we carried out a study to evaluate this mediation hypothesis by the means of structural equation modeling in a large sample of 148 schizophrenia patients. The review comprised 15 studies. All but one study provided evidence for the mediating role of social cognition both in cross-sectional and in longitudinal designs. Other variables like motivation and social competence additionally mediated the relationship between social cognition and functional outcome. The mean effect size of the indirect effect was 0.20. However, social cognitive domains were differentially effective mediators. On average, 25% of the variance in functional outcome could be explained in the mediation model. The results of our own statistical analysis are in line with these conclusions: Social cognition mediated a significant indirect relationship between neurocognition and functional outcome. These results suggest that research should focus on differential mediation pathways. Future studies should also consider the interaction with other prognostic factors, additional mediators, and moderators in order to increase the predictive power and to target those factors relevant for optimizing therapy effects.
认知障碍目前被认为是功能领域的重要决定因素，也是精神分裂症有前途的治疗目标。然而，神经认知和社会认知之间相互依存关系的确切性质，以及这些因素对适当功能的相对贡献仍不清楚。本文的目的是系统地回顾研究社会认知作为精神分裂症神经认知表现和功能结果之间中介变量的研究结果和方法。此外，我们通过结构方程建模在 148 名精神分裂症患者的大样本中进行了一项研究，以评估这种中介假设。综述包括 15 项研究。除了一项研究外，所有研究都在横断面和纵向设计中提供了社会认知具有中介作用的证据。其他变量，如动机和社会能力，也中介了社会认知和功能结果之间的关系。间接效应的平均效应大小为 0.20。然而，社会认知领域是不同的有效中介。平均而言，功能结果的 25%可以用中介模型来解释。我们自己的统计分析结果与这些结论一致：社会认知在神经认知和功能结果之间的间接关系中起中介作用。这些结果表明，研究应侧重于不同的中介途径。未来的研究还应考虑与其他预后因素、其他中介因素和调节因素的相互作用，以提高预测能力，并针对那些与优化治疗效果相关的因素。
