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Functional Capacity as a Predictor of Everyday Functioning in Patients with Schizophrenia
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall purpose of this thesis is to increase knowledge of the concept of functional capacity and how it is related to everyday functioning for adult patients with schizophrenia spectrum disorders. The thesis comprises three papers (Papers I-III) based on empirical data from a clinically representative sample of outpatients. The results in the first study (Paper I) indicated that the Swedish version of University of California San Diego Performance-based Skills Assessment-Brief (UPSA-B) is a reliable instrument, with good psychometric properties in terms of both validity and reliability. UPSA-B is a performance-based instrument used to assess functional capacity, i.e. the patient’s ability to perform certain everyday tasks, necessary for independent functioning, in a controlled setting. In the second study (Paper II), the aim was to investigate if and how demographic variables and illness activities, together with functional capacity, contribute to predicting real-world functioning milestones. Functional capacity was mainly associated with education level and housing situation. In the third study (Paper III), the aim was to investigate how the patient's self-rating ability regarding functional performance relates to neurocognitive performance and real-world functional performance. The results showed that 37% of patients overestimate their functional performance. The results also showed that clinicians seem to have greater difficulty assessing patients who overestimate their functioning. In summary, this thesis states that using UPSA-B to measure functional capacity offers considerable advantages and plays an important role in capturing functional outcomes. The importance of taking control of limited self-rating ability in patients with schizophrenic spectrum disorders is also demonstrated.

Abstract [en]

The overall purpose of this thesis is to increase knowledge about the concept of functional capacity and the way it is related to everyday functioning for adult patients with schizophrenia spectrum disorders. UCSD Performance-based Skill Assessment-Brief (UPSA-B) is a performance based instrument used to assess functional capacity, the patient’s ability to perform certain everyday tasks in a controlled setting. The result in Paper I indicated that the Swedish version of UPSA-B is a reliable instrument with good psychometric properties. The aim in Paper II was to investigate if and how, demographic variables and illness activities together with functional capacity contribute to predict real-world functioning milestones. Functional capacity was mainly associated with education level and housing situation. In Paper III the aim was to investigate how the patient's self-rating ability regarding functional performance relates to neurocognitive performance and real-world functional performance. The results showed that 37 % of patients overestimate their ability of functional performance. In sum, this thesis states that using UPSA-B to measure functional capacity has great advantages and plays an important role in capturing functional outcomes.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2019. , p. 86
Series
Karlstad University Studies, ISSN 1403-8099 ; 2019:2
Keywords [en]
Schizophrenia, Functional capacity, Everyday functioning, Self-awareness, Assessment instrument
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:kau:diva-70681ISBN: 978-91-7063-833-6 (print)ISBN: 978-91-7063-866-4 (electronic)OAI: oai:DiVA.org:kau-70681DiVA, id: diva2:1276571
Public defence
2019-02-22, 1B 309 Sjöströmsalen, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2019-02-01 Created: 2019-01-08 Last updated: 2019-06-05Bibliographically approved
List of papers
1. Psychometric properties of a performance-based measurement of functional capacity
Open this publication in new window or tab >>Psychometric properties of a performance-based measurement of functional capacity
2012 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 197, no 3, p. 290-294Article in journal (Refereed) Published
Abstract [en]

The UCSD Performance-based Skills Assessment - Brief version (UPSA-B) describes the functions of patients without negative influences of environmental factors such as unemployment or shortage in housing. The aim of the present study is to further explore the psychometric properties of the UPSA-B as well as to ensure that the Swedish version can be used in clinical practice and for research purposes. Participants were 211 patients, 135 men and 76 women, diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder. Results indicate that the UPSA-B is a reliable instrument with good psychometric properties regarding validity and reliability. The instrument also had a capacity to reveal differences between various patient groups, both diagnostic groups and groups based on remission status. The conclusion drawn is that the UPSA-B is a valuable instrument that could be used in future cross-national studies to describe the level of functioning for patients with schizophrenia and other psychotic illnesses.

Place, publisher, year, edition, pages
Elsevier, 2012
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-26955 (URN)10.1016/J.PSYCHRES.2011.11.002 (DOI)000308768100019 ()
Available from: 2013-04-19 Created: 2013-04-16 Last updated: 2019-01-08Bibliographically approved
2. Predicting real-world functional milestones in schizophrenia
Open this publication in new window or tab >>Predicting real-world functional milestones in schizophrenia
2016 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 242, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Schizophrenia is a severe disorder that often causes impairments in major areas of functioning, and most patients do not achieve expected real-world functional milestones. The aim of this study was to identify which variables of demography, illness activity, and functional capacity predict patients' ability to attain real-world functional milestones. Participants were 235 outpatients, 149 men and 86 women, diagnosed with schizophrenia spectrum disorder. Our results showed that younger patients managed to achieve a higher level of functioning in educational level, marital status, and social contacts. Patients' functional capacity was primarily associated with educational level and housing situation. We also found that women needed less support regarding housing and obtained a higher level of marital status as compared with men. Our findings demonstrate the importance of considering current symptoms, especially negative symptoms, and remission stability over time, together with age, duration of illness, gender, educational level, and current functional capacity, when predicting patients' future real-world functioning. We also conclude that there is an advantage in exploring symptoms divided into positive, negative, and general domains considering their probable impact on functional achievements.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Applied Psychology
Research subject
Psychology with an emphasis on medical psychology
Identifiers
urn:nbn:se:kau:diva-45865 (URN)10.1016/j.psychres.2016.05.015 (DOI)000381844200001 ()27235985 (PubMedID)
Projects
Clinical Long-term Investigation of Psychosis in Sweden (CLIPS)
Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2019-06-10Bibliographically approved
3. Overestimated function in patients with schizophrenia: A possible risk factor for inadequate support?
Open this publication in new window or tab >>Overestimated function in patients with schizophrenia: A possible risk factor for inadequate support?
2018 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, article id S0920-9964(18)30678-9Article in journal (Refereed) Epub ahead of print
Abstract [en]

People with schizophrenia often demonstrate an impaired ability to assess and report aspects of their everyday functioning, and the aim of this study is to investigate how patients' self-rating ability regarding functional performance relates to neurocognitive performance and real-world functional performance. A total of 222 outpatients with a schizophrenia spectrum disorder participated in this study. They were divided into groups based on their self-rating ability (determined using self-rating questions) and their observed functional capacity (the UCSD Performance-Based Skills Assessment-Brief, UPSA-B). The results showed that patients with impaired functional capacity perform at a similar cognitive level, regardless of their self-rating ability. When comparing patients with unimpaired function to those with impaired function, we found differences in two cognitive domains; premorbid functioning and executive functioning. The results also reveal that clinicians seem to have greater difficulty assessing patients who over-estimate their functioning. Consequently, when clinicians assessed the patients with the Specific Levels of Functioning Scale (SLOF) no significant differences were found between the group with unimpaired function and the group of overestimators. Patients who overestimate their functioning risk receiving inadequate treatment and support.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Functional capacity, Introspective accuracy, Neurocognition, Real-world functional outcomes, Schizophrenia, Self-awareness
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-70680 (URN)10.1016/j.schres.2018.11.027 (DOI)000467810100028 ()30514644 (PubMedID)
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-05-31Bibliographically approved

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