Construct validity of a newly developed instrument: profile of occupational engagement in people with schizophrenia, POES

It is highly relevant to estimate to what extent a person with schizophrenia engages in occupations and participates in different life situations in order to understand the determinants of well-being in this group of people. This study aimed at examining the construct validity of the instrument Profile of Occupational Engagement in persons with Schizophrenia, POES. Global Assessment of Functioning, GAF, and a scale measuring Satisfaction with daily occupations and Activity level were chosen as standards against which POES was validated. As hypothesized, moderate associations were found between POES and GAF (0.73), Activity level (0.70), and Satisfaction with daily occupations (0.50). Regarding the separate items of POES, the items that concerned the range of occupations performed had the strongest association with Activity level, and the items that concerned ongoing occupations, i.e. Routines and Extent of performing meaningful occupations, correlated most strongly with Satisfaction with daily occupations. Thus, the strongest associations were found for the expected items. Altogether, POES seems to possess satisfactory construct validity and be a construct in its own right, as indicated by correlations of expected size and direction with the selected instruments and for expected items.     

Construct validity and reliability of working memory tasks for people with aphasia

Background: Although several studies have examined working memory in people with aphasia, there is little information about the psychometric properties of tasks used to measure working memory in this population.

Aims: The aims of this study were (1) to examine the construct validity, internal consistency, and test-retest reliability of several working memory tasks and (2) to determine which tasks were feasible to use with people with a wide range of aphasia severities.

Methods & Procedures: In experiment one, non-brain-damaged adults (n = 47) completed a set of working memory tasks that were designed for use with people with aphasia. The tasks included 1-back, 2-back, listening span and forward and backward versions of picture span and square span. Construct validity was assessed by correlating performance on the new tasks with a composite score based on three well-established working memory tasks with known psychometric properties. Ten older adults completed the testing battery twice to measure test-retest reliability. Internal consistency was estimated using split-half reliability. In experiment two, people with aphasia (n = 12) completed the new working memory tasks.

Outcomes & Results: The picture span tasks demonstrated acceptable test-retest reliability, internal consistency, and construct validity. Controls showed ceiling effects on 1-back and people with aphasia showed floor effects on listening span. Both the square span tasks and n-back showed poor internal consistency for people with aphasia and age-matched controls.

Conclusions: A composite score based on the forward and backward versions of picture span provides a measure of verbal working memory with acceptable construct validity, internal consistency and test-retest reliability and can be completed by non-brain-damaged adults and people with aphasia.     

French version of the profiles of occupational engagement in people with severe mental illness: Translation,adaptation, and validation

Occupational engagement is affected in many persons with severe mental illness (SMI) because of personal, occupational, and environmental issues. However, no French assessment tool measuring occupational engagement in these persons is currently available. The objectives of the study were to translate the “Profiles of Occupational Engagement in People with Severe Mental Illness” (POES), including a time use diary and an interview, and to measure the interrater reliability of the French version. First, a transcultural validation process of the English version of the POES into French was completed. Second, to determine interrater reliability, ten evaluators assessed 23 participants with an SMI. Specific concepts were clarified with the author of the original tool. No items were added or removed following the translation process. An interview guide was developed to assist the interview on occupational engagement. Analyses indicated high interrater reliability (ICC?=?0.94). French-speaking clinicians will be able to use a validated French version of the POES to better capture occupational engagement in people with SMI, facilitating the individualisation of interventions.     

Alexithymia and global psychosocial functioning: a study on patients with skin disease

OBJECTIVE: The relationship between alexithymia and psychosocial functioning has been investigated in a few studies using indirect measures of adaptation. We aimed at directly evaluating the relationship between alexithymia and global psychosocial functioning, as measured by a standardised scale. METHODS: A large, consecutive sample of dermatological inpatients (N=545) completed the 20-item Toronto Alexithymia Scale and the Skindex-29 and were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders and the Global Assessment of Functioning (GAF) scale. RESULTS: Multiple regression analysis was used to control for likely determinants of psychosocial functioning such as age, sex, education, burden of skin symptoms, and psychiatric morbidity. The GAF score was associated with psychiatric morbidity (beta=-.63, P<.001), alexithymia (in particular, the difficulty identifying feelings subscale) (beta=-.19, P<.001), and burden of skin symptoms (beta=-.07, P<.05). CONCLUSION: Given the well-known association between poor psychosocial functioning and several behavioural risk factors for health, our study may provide a further reason for clinicians to pay attention to alexithymic features among their patients.     

Social cognition,social competence,negative symptoms and social outcomes: Inter-relationships in people with schizophrenia

Social deficits are common in people with schizophrenia and the treatment of deficits in social competence has been a long-time treatment strategy. However, negative symptoms and social cognitive deficits also contribute to social dysfunction. In this study, we examined the correlations between everyday social outcomes, a performance based measure of social competence, and performance on 8 different social cognition tests in 179 patients with schizophrenia. Social cognition, social competence, and motivation-related negative symptoms accounted for 32% of the variance in real-world social outcomes. In addition, two different social cognition tests, along with expression-related negative symptoms accounted for 32% of the variance in performance-based assessments of social competence. These data suggest that negative symptoms exert an important influence on social outcomes and social competence, but not social cognition, and that social cognition and social competence exert separable influences on real-world social outcomes. Improving social outcomes seems to require a multi-faceted approach which considers social cognition, social competence, and negative symptoms.     

Evaluation of a newly developed measure of theory of mind: The virtual assessment of mentalising ability

This study examined the reliability and validity of the Virtual Assessment of Mentalising Ability (VAMA). The VAMA consists of 12 video clips depicting a social drama imposed within an interactive virtual environment with questions assessing the mental states of virtual friends. Response options capture the continuum of ability (i.e., impaired, reduced, accurate, and hypermentalising) within first- and second-order cognitive and affective theory of mind (ToM). Sixty-two healthy participants were administered the VAMA, three other ToM measures, and additional measures of neurocognitive abilities and social functioning. The VAMA had sound internal consistency and high test-retest reliability. Significant correlations between performance on the VAMA and other ToM measures provided preliminary evidence of convergent validity. Small to moderate correlations were observed between performance on the VAMA and neurocognitive tasks. Further, the VAMA was found to correlate significantly with indices of social functioning and was rated as more immersive, more reflective of everyday ToM processes, and was afforded a higher recommendation than an existing computer-based ToM task. These results provide potential evidence that the VAMA is an ecologically valid tool that is sensitive to the spread of ability that can occur in ToM subprocesses and may be a valuable addition to existing ToM measures. Future research should explore the validity and utility of the VAMA in larger, more diverse samples of healthy adult and clinical populations.     

Associations of Clozapine Use With Psychosocial Functioning and Quality of Life in Patients With Schizophrenia: A Community-Based Cross-Sectional Study

ObjectiveMore attempts have been made recently to improve psychosocial functioning and quality of life in patients with schizophrenia, due to their crucial role in long-term outcomes. Previous studies on the effects of clozapine on psychosocial functioning have been limited in terms of generalizability and application to clinical practice. This study examined the relationship of clozapine use with psychosocial functioning and quality of life in patients with schizophrenia in a real-world setting. MethodsData were obtained from a survey targeting community-dwelling patients with schizophrenia. The Behavior and Symptom Identification Scale (BASIS) and Satisfaction with Life Scale (SWLS) were administered to evaluate psychosocial functioning and quality of life, and patients were classified into Clozapine and Non-clozapine groups. Group differences were assessed using ANCOVA, with additional sensitivity analyses for participants on atypical antipsychotic medications only. ResultsOf 292 patients, the Clozapine group (n=34) had significantly better psychosocial functioning and quality of life than the Nonclozapine group (n=258), as demonstrated by their low BASIS score (F=4.651, df=1, 290, p=0.032) and high SWLS score (F=14.637, df=1, 290, p<0.001). Similar findings for psychosocial outcomes were observed in the analyses of the atypical antipsychotic subgroup (n=195). ConclusionFor optimal recovery in schizophrenia, restoration of impaired social functioning and enhanced satisfaction with life are essential. In this study, clozapine use was related to high levels of psychosocial functioning and quality of life in real-world settings. Further research on the causal relationship between clozapine use and psychosocial functioning is needed.     

Predictive Factors of Social Functioning in Patients with Schizophrenia: Exploration for the Best Combination of Variables Using Data Mining

Objective

This study aimed to use data mining to explore the significantly contributing variables to good social functioning in schizophrenia patients.

Methods

The study cohort comprised 67 schizophrenia patients on stable medication. A total of 51 variables (6 demographic data, 3 illness history, 22 social cognition, 16 neurocognition, 4 psychiatric symptoms) were input into a data-mining decision tree using the Answer Tree program to find the pathway for the best social functioning.

Results

Several contributing factors for good social functioning were found. Continuous attention was the strongest contributing factor. Three variables involving best social functioning included good continuous attention, good theory of mind (TOM), and low sensitivity of disgust emotion.

Conclusion

Our results confirmed the mediating roles of social cognition between neurocognition and functional outcomes, and suggested that social cognition can significantly predict social functioning in schizophrenia patients.     

Functional cooking skills and neuropsychological functioning in patients with stroke: An ecological validity study

Efforts to relate neuropsychological performance to real-world task functioning have predominantly yielded lackluster results, typically with neuropsychological performance accounting for modest amounts of variance in function. Nonetheless, the ecological validity of neuropsychological measures for predicting functional abilities remains a strong research interest and clinical necessity. This study relates neuropsychological performance to performance on a standardised cooking task (Rabideau Kitchen Evaluation – Revised; RKE-R) in persons with stroke. Results showed that while the composite score of mean neuropsychological performance had the largest association with meal preparation, several neuropsychological measures were significantly related to the RKE-R. Groups of left and right hemisphere stroke patients were not significantly different in terms of RKE-R performance. These results suggest that functional cooking task performance is related to intact cognitive abilities in delayed verbal memory, simple auditory attention, and visuospatial skills, as well as overall cognitive performance. Implications for neuropsychologists are discussed.     

Reliability and validity of a Norwegian version of the quality of life in epilepsy inventory (QOLIE-89)

PURPOSE: To develop a Norwegian version of the Quality of Life in Epilepsy Inventory (QOLIE-89) and to confirm its psychometric properties. METHODS: The QOLIE-89 was adapted to Norwegian language through a translation-backtranslation procedure. The assessment included 397 patients with epilepsy. We assessed internal consistency and test-retest reliabilities. Construct validity was assessed by correlating scales with items of the 15D health status questionnaire, and discriminant validity was assessed by comparing scores for known groups. RESULTS: The internal consistency reliability (Cronbach's alpha, 0.76-0.92) and test-retest reliability (intraclass correlation coefficient, 0.67-0.96) for the individual domains were acceptable. Spearman's rank correlations between QOLIE-89 domain scores and corresponding 15D single-item scores were high (p, 0.47-0.76), and generally higher than the associations between noncorresponding items. Most QOLIE-89 items discriminated well between patients according to seizure status, psychiatric comorbidity, and working status; less well after antiepileptic drug use and neurologic comorbidity. CONCLUSIONS: In this cross-sectional survey, the Norwegian version of the QOLIE-89 was reliable and showed properties supporting construct validity, at a level comparable with the original U.S. version.     

Naturalistic tasks performed in realistic environments: a review with implications for neuropsychological assessment

Objective: Understanding functional abilities for those with neurologic disorders is a growing area of investigation. In this paper, performance-based naturalistic tasks used to assess cognitive and functional deficits were reviewed to determine current evidence for effectiveness as valid and reliable assessment measures and to make recommendations for future research.Method: Performance-based naturalistic tasks were defined as observable, rule-based, open-ended tasks completed in an environment that either mimics the real world or is the real world. Thirty-eight studies, discussed by the environment in which the task was performed (i.e. vocational, kitchen, hospital/store, and home), were reviewed.Results: Many studies were found to have significant methodological limitations (e.g. low sample size) and few studies evaluated the relationship between performance on the naturalistic task and everyday functioning. The efficacy of using naturalistic tasks to better understand functional status has yet to be clearly demonstrated across neurologic populations. Numerous factors, including ease of use, limited research on how to best utilize these tasks, and cost impact the use of naturalistic tasks. Nonetheless, given the promising theoretical foundation, opportunities are ripe for further development of assessment strategies that use contextually relevant environments and allow for enhanced safety and controllability of tasks, increased face validity, capitalization on automatic processes, and improved ecological validity.Conclusions: Future research is needed to increase the knowledge base regarding the use of naturalistic tasks, especially as they relate to everyday functioning, because of the potential benefits to advance the standard of care for individuals with neurologic conditions.     

A snapshot of cognitive functioning: Deriving a tool for the efficient assessment of cognition in schizophrenia and other chronic psychiatric disorders in a real-world inpatient setting

Previous research has led to the development of short batteries of tests that efficiently measure the cognitive functioning of individuals with schizophrenia. To attempt to replicate previous findings, we applied an empirical test selection strategy to archival cognitive test data of two non-overlapping inpatient samples of individuals with schizophrenia or schizoaffective disorder (total N=110). We then extended previous findings by applying the empirical test selection strategy to the archival data of two non-overlapping inpatient samples of individuals with various psychiatric disorders (total N=149). For each sample, tests were selected by examining the relationships between individual test scores and averaged test scores representing global cognitive functioning while taking into account test administration times. Across patient samples, digit symbol coding tasks, verbal fluency tasks, and tests with a processing speed component (Trail Making Test Part A and Stroop) emerged as efficient and effective indicators of overall cognitive functioning. A brief cognitive assessment tool incorporating coding, fluency, and processing speed tasks would provide a valid and clinically useful snapshot of a patient's level of cognitive functioning if more comprehensive testing cannot be completed.     

Premorbid functioning of patients with first-episode nonaffective psychosis: a comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores

BACKGROUND: Motivated by a previous study among male veterans [Allen, D.N., Frantom, L.V., Strauss, G.P., van Kammen, D.P., 2005. Differential patterns of premorbid academic and social deterioration in patients with schizophrenia. Schizophr. Res. 75, 389-397], the present analysis examined: (1) patterns of premorbid academic and social functioning during childhood, early adolescence, and late adolescence, and (2) associations between these premorbid functioning dimensions and a number of clinical variables. METHODS: Data on premorbid functioning were collected using the Premorbid Adjustment Scale (PAS) in 95 hospitalized first-episode patients. Analyses were similar to those conducted by Allen and colleagues (2005). RESULTS: Deterioration was evident in both academic and social functioning from childhood to early adolescence, along with a pronounced/accelerated deterioration in academic functioning from early adolescence to late adolescence, occurring in both male and female patients. Age at onset of prodromal symptoms was predicted by childhood/early adolescent/late adolescent academic functioning scores, and age at onset of psychotic symptoms was significantly associated only with childhood academic functioning. Severity of negative symptoms was predicted by childhood and late adolescent social functioning scores, and severity of general psychopathology symptoms was predicted by late adolescent academic functioning, as well as childhood and late adolescent social functioning scores. CONCLUSIONS: Consistent with prior findings, deterioration in premorbid functioning appears to be more pronounced in the academic than social dimension of the PAS. Some PAS scores are predictive of ages at onset of prodrome/psychosis and severity of psychotic symptoms. Ongoing research on premorbid adjustment in schizophrenia may have implications for future prevention goals.     

Cognitive and Clinical Predictors of Work Outcomes in Clients with Schizophrenia Receiving Supported Employment Services: 4-year Follow-Up

In a prior study we showed that cognitive functioning was a modest predictor of work and supported employment services over 2-years in 30 clients with schizophrenia, whereas symptoms were not (McGurk et al. (2003). Psychiatric Services, 58, 1129–1135). In order to evaluate whether the long-term provision of supported employment services reduced the impact of cognitive functioning on work, we examined the relationships between cognitive functioning and symptoms assessed after the initial 2 years of the program, and work and vocational services over the following 2 years (3–4 years after joining the program). Cognitive functioning was more predictive of work during the latter 2 years of the study than the first 2 years, and a similar but weaker pattern was present for the prediction of employment services. Symptoms remained weak predictors for both time periods. In addition, learning and memory and executive functions were strongly correlated with job task complexity during the 3–4 year follow-up, but not the 1–2 year follow-up, suggesting that employment specialists were able to improve their ability to match clients to jobs based on their cognitive skills. Furthermore, the specific associations between cognitive functioning, services, and work outcomes changed from years 1–2 to years 3–4, suggesting a dynamic interplay between these factors over the long-term, rather than static and unchanging relationships. The findings indicate that rather than supported employment services reducing the impact of cognitive functioning on long-term competitive work, the impact actually increases over time, suggesting that efforts to improve cognitive functioning (e.g., cognitive rehabilitation) may optimize employment outcomes in schizophrenia.     

暴力危险性筛查量表中文版在精神分裂症患者中的信度与效度研究

目的：引入暴力危险性筛查量表（violenceriskscreening-10,V—RISK-10）,对V—RISK-10中文版在精神分裂症患者中的信度与效度进行检验。方法：对英文版V—RISK-10进行翻译和修订,以109例精神分裂症患者为评估对象,完成一般情况调查表、V—RISK-10中文版、卫生部危险性评估、修订版外显行为攻击量表（MOAS）的测评。其中14例患者由2位评估者独立评估V—RISK-10中文版,49例患者2周后重测V—RISK．10中文版。结果：V—RISK-10中文版9个条目的鉴别力良好,内部一致性系数0．833（P〈0．01）。评分者信度（斯皮尔曼等级相关系数：r=0．655—0．899）、重测信度（Kappa=0．536—1．000）较好（P〈0．ol或P〈0．05）。V—RISK．10中文版中7个条目得分与其综合评定建议分级（Kendal和谐系数为0．387～0．685）、危险性评估分级（Kendal和谐系数为0．319～0．618）、MOAS总分（皮尔逊相关系数：,=0,301～0．585）均显著正性相关（P均〈0．01）;关联效度理想。结论：V—RISK-10中文版在精神分裂症患者中的信度与关联效度良好。     

Seizure disorders in people with intellectual disability: an analysis of differences in social functioning, adaptive functioning and maladaptive behaviours

The present study is an investigation into the effects of seizure disorders/epilepsy on psychopathology, social functioning, adaptive functioning and maladaptive behaviours using a sample of 353 people diagnosed with a seizure disorder, and either severe or profound intellectual disability. People with a diagnosis of seizure disorder were found to have significantly less social and adaptive skills when compared to developmentally disabled controls with no seizure disorder diagnosis. Additionally, patterns of maladaptive behaviours were identified for individuals with seizure disorders and found to be similar to those found in people without seizure activity. The implications of the present findings are discussed.     

Exploring the need for a new UK occupational therapy intervention for people with dementia and family carers: Community Occupational Therapy in Dementia (COTiD). A focus group study

Objectives: In the Netherlands, Graff et al. found Community Occupational Therapy in Dementia (COTiD) demonstrated benefits to people with dementia and family carers. In this study, focus groups took place with people with dementia and family carers to explore how to make COTiD relevant to the UK context.

Method: Six focus groups (three with people living with dementia (n = 18) and three with family carers (n = 21)) took place. Participants were asked for their impressions of the intervention, the extent to which it could meet their needs, and what modifications were needed. Audio-recordings of the groups were transcribed and analysed.

Results: Three key themes emerged covering ‘loss and living with dementia’, ‘what helped us’, and ‘consistency and continuity’. People with dementia and family carers spoke about the impact of their diagnosis on them and their family and what strategies helped. Issues such as timing, follow-up, and the importance of an early intervention in preventing crises were highlighted. There was some concern over the length of the intervention and the disruption it might cause to current schedules.

Conclusion: Overall, participants were optimistic about COTiD being used in the United Kingdom if it was to be introduced in a flexible and timely manner, incorporating the needs and existing strategies of the person with dementia. These outcomes have led to changes, such as incorporating more flexibility into COTiD, being made to the intervention prior to its implementation in the United Kingdom.