How Neurocognition and Social Cognition Influence Functional Change During Community-Based Psychosocial Rehabilitation for Individuals with Schizophrenia

TLDR

The study examined how baseline neurocognition and social cognition predict initial functional status and rates of functional improvement in intensive community‑based psychosocial rehabilitation for schizophrenia, and whether service intensity moderates these relationships. A prospective 12‑month cohort of 125 individuals with schizophrenia or schizoaffective disorder recruited at four community‑based rehabilitation facilities was followed, with 102 completing the protocol. Higher baseline neurocognitive and social cognitive scores were associated with better initial functioning and faster functional gains, while greater service intensity accelerated improvement and moderated the cognition‑function relationships, underscoring heterogeneity in rehabilitative outcomes.

Abstract

The purpose of this study was to assess how neurocognition and social cognition were associated with initial functional level and with rates of functional change in intensive community-based psychosocial rehabilitation interventions that have been shown to yield significant functional change for individuals diagnosed with schizophrenia. We also examined how service intensity was associated with rates of change and whether it served as a moderator of the relationship between functional change and both neurocognition and social cognition. The sample consisted of 125 individuals diagnosed with schizophrenia or schizoaffective disorder who were recruited upon admission to 1 of 4 community-based psychosocial rehabilitation facilities and were followed prospectively for 12 months. One hundred and two subjects completed the 12-month protocol. The findings suggested that (i) the initial level of psychosocial functioning was related to both social cognition and neurocognition at baseline, (ii) when significant rehabilitative change occurs, higher neurocognition and social cognition scores at baseline predicted higher rates of functional change over the subsequent 12 months, (iii) greater service intensity was related to higher rates of improvement in functional outcome over time, and (iv) service intensity moderated the relationship between neurocognition and initial functional level and moderated the relationship between social cognition and the rates of functional change at a trend level. These findings have relevance to our understanding of the heterogeneity in functional rehabilitative outcomes, to our understanding of the conditions of rehabilitative change and for the design of psychosocial interventions in the community.