Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA.
Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA.
Psychol Med. 2018 Dec;48(16):2776-2785. doi: 10.1017/S0033291718000442. Epub 2018 Mar 4.
Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context.
We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions.
We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia.
The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
神经认知缺陷通常被视为精神分裂症的核心特征，也是功能障碍的主要决定因素。然而，我们的临床观察表明，在标准化测试中得分处于受损范围内的个体在复杂的现实环境中可以可靠地表现更好，尤其是当表现嵌入积极的社会情感背景中时。
我们分析了关于非神经认知因素对测试表现影响的文献，以阐明其贡献。
我们确定了七个对神经认知测试表现有显著贡献的非神经认知因素：意志减退、功能失调态度、努力、压力、负面情绪、社交回避和紊乱症状。然后，我们提出了一个基于功能失调（如失败主义）态度及其对动机和持续任务参与的影响的替代模型。我们证明这些因素可以解释阴性症状、神经认知测试表现和功能结果的大量差异。然后，我们证明以恢复为导向的认知疗法——它源自于这个替代模型，主要针对功能失调的信念——在治疗功能低下的精神分裂症患者方面取得了成功。
在文献中，神经认知损伤对精神分裂症患者现实世界功能不良的贡献可能被夸大了，甚至相对于非神经认知因素可能有限。我们提出了进一步研究的建议，以更精确地量化态度/动机与神经认知因素在精神分裂症中的贡献。
