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Contributions of Neurocognition and Social Cognition

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Contributions of Neurocognition and Social Cognition PATHWAYS TO FUNCTIONAL IMPAIRMENT IN SCHIZOPHRENIA: CONTRIBUTIONS OF NEUROCOGNITION AND SOCIAL COGNITION A dissertation submitted to Kent State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy by Amanda McCleery August, 2012 i Dissertation written by Amanda McCleery B.S., University of Toronto, Canada, 2004 M.A., Kent State University, USA, 2009 Ph.D., Kent State University, USA, 2012 Approved by _Nancy M Docherty__________________ , Chair, Doctoral Dissertation Committee _John Gunstad_______________________ , Members, Doctoral Dissertation Committee _Manfred van Dulmen_________________ _Colleen Novak______________________ _Vera Camden_______________________ Accepted by _Maria Zaragoza_____________________ , Chair, Department of Psychology _Timothy Moerland___________________ , Dean, College of Arts and Sciences ii TABLE OF CONTENTS LIST OF FIGURES ...................................................................................................................... V LIST OF TABLES ...................................................................................................................... VI ACKNOWLEDGEMENTS ......................................................................................................VII CHAPTER 1 INTRODUCTION ..................................................................................................1 1.1 Social Functioning Deficits in Schizophrenia .......................................................................2 1.2 Social Cognitive Deficits in Schizophrenia...........................................................................3 1.3 Neurocognitive Impairment in Schizophrenia.....................................................................15 1.4 Are Social Cognitive Deficits Fully Accounted for by Impaired Neurocognition in Schizophrenia?...............................................................................................................................18 1.5 Summary and Aims of Present Study..................................................................................24 CHAPTER 2 METHOD..............................................................................................................27 2.1 Participants ..........................................................................................................................27 2.2 Procedure.............................................................................................................................29 2.3 Measures..............................................................................................................................29 2.4 Data Analysis ......................................................................................................................36 CHAPTER 3 RESULTS..............................................................................................................46 3.1 Descriptive Statistics ...........................................................................................................46 3.2 Bivariate Correlations Between Study Variables ................................................................50 3.3 Confirmatory Factor Analysis .............................................................................................55 3.4 Structural Regression Analyses...........................................................................................61 CHAPTER 4 DISCUSSION........................................................................................................71 REFERENCES.............................................................................................................................79 APPENDIX A . SHIPLEY INSTITUTE OF LIVING SCALE .............................................100 iii APPENDIX B . WISCONSIN CARD SORT TASK-64 .........................................................101 APPENDIX C . TRAILMAKING TEST B .............................................................................102 APPENDIX D . CONTINUOUS PERFORMANCE TASK – IDENTICAL PAIRS ...........105 APPENDIX E . DIGIT SPAN...................................................................................................106 APPENDIX F . TRAILMAKING TEST A .............................................................................107 APPENDIX G . FACIAL EMOTION IDENTIFICATION TEST .......................................110 APPENDIX H . BELL-LYSAKER EMOTION RECOGNITION TEST ............................111 APPENDIX I . PROFILE OF NONVERBAL SENSITIVITY..............................................112 APPENDIX J . HINTING TASK .............................................................................................113 APPENDIX K . BRUNE TASK................................................................................................114 APPENDIX L . ASSESSMENT OF INTERPERSONAL PROBLEM SOLVING SKILLS ........................................................................................................................................126 APPENDIX M . SOCIAL FUNCTIONING SCALE..............................................................140 APPENDIX N . RESULTS: MULTIPLY IMPUTED DATASETS (M=5)...........................154 iv LIST OF FIGURES Figure 1 Proposed a) one-factor and b) two-factor models of neurocognition and social cognition .................................................................................................................... 37 Figure 2. Proposed structural equation models................................................................. 39 Figure 3. Two-factor confirmatory factor analysis model, standardized solution (AIPSS subsample, n=91)....................................................................................................... 57 Figure 4. One-factor confirmatory factor analysis model, standardized solution (AIPSS subsample, n=91)....................................................................................................... 58 Figure 5. Two-factor confirmatory factor analysis model, standardized solution (total sample, n=120). ......................................................................................................... 59 Figure 6. One-factor confirmatory factor analysis model, standardized solution (total sample, n=120). ......................................................................................................... 60 Figure 7. Unique effects model, standardized solution (AIPSS subsample, n=91).......... 63 Figure 8. Indirect effects model, standardized solution (AIPSS subsample, n=91). ........ 65 Figure 9. Distribution of parameter estimates for direct (path c) and indirect (path a x b) effects (AIPSS subsample, n=1000 converged simulations)..................................... 66 Figure 10. Unique effects model, standardized solution (total sample, n=120). .............. 68 Figure 11. Indirect effects model, standardized solution (total sample, n=120)............... 69 Figure 12. Distribution of parameter estimates for direct (path c) and indirect (path a x b) effects (total sample, n=881 converged simulations). ............................................... 70 v LIST OF TABLES Table 1. Sample characteristics (n=123)........................................................................... 28 Table 2. Descriptive statistics (total sample, n=123)........................................................ 47 Table 3. Descriptive statistics (AIPSS subsample, n=94)................................................. 49 Table 4. Bivariate correlations between study variables (n=123)..................................... 52 vi ACKNOWLEDGEMENTS My deepest thanks to my mentor, Dr. Nancy Docherty – I feel incredibly fortunate to have had the privilege to train with her. Her dedication to research, mentorship, and professional stewardship is inspiring, and I am grateful for all the encouragement, guidance, support, and generosity she provided throughout my time at Kent. Thank you to Jennifer Aakre, Marielle Divilbiss, Kristen Cimera, and the Docherty lab members for their help and support. Thanks for all the thoughtful comments and insight from my committee members: Drs. John Gunstad, Manfred van Dulmen, Colleen Novak, Vera Camden, and Susan Roxburgh. I also would like to acknowledge the research participants who dedicated their time and effort to be part of the project, as well as the staff at Community Support Services for facilitating data collection for Dr. Docherty’s grant, from which this dissertation is derived. Completing a Ph.D. program is pretty arduous and I cannot express how lucky I feel to have had the love, support, and understanding of my family and friends throughout this process. Keith Romanuik: you’re pretty awesome, bud. I couldn’t ask for a better friend or partner in life. Big thanks to my mum and dad for encouraging me to take risks and for their unconditional support. I also want to thank my dad for always responding to my constant stream of questions when I was a kid with “well, let’s look it up” – although I found it super annoying back then, I will (begrudgingly) admit that it started me off on the right foot for a career in research! Amanda McCleery May 9, Kent, Ohio vii CHAPTER 1 Introduction Schizophrenia is marked by impairment across a variety of domains including neurocognition, social cognition, and social functioning. Although robust associations between neurocognition (e.g., executive functions, attention, memory) and functional outcome have been reported in the literature (e.g., Addington
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