YEARS

2007-2013

AUTHORS

Thomas L. Patterson

TITLE

Validating Assessments of Real-World Outcome

ABSTRACT

DESCRIPTION (provided by applicant): This collaborative study (the P.I. of whose companion application is Dr. Philip D. Harvey) aims to validate assessments of real-world (RW) functional outcomes in people with schizophrenia. Schizophrenia patients are often impaired in their social and occupational functioning, their self-care, and their ability to live independently. Not only do these impairments worsen the patient's quality of life, they also increase the societal cost of his or her illness. While these impairments are evident in most patients, surprisingly little attention has been paid to the validity of assessments of these outcomes. Since the current tool of choice in predicting functional disability in schizophrenia is neuropsychological (NP) testing, proposals to reduce disability have tended to focus on short-term treatment of cognitive impairments. However, such trials are not well suited either to induce or identify improvements in real-world functioning. Some researchers have proposed switching to measures of functional capacity instead, but recent evidence suggests that the correlations obtained between functional-capacity measures, NP test results, and real-world outcomes are largely a function of the real-world rating scale that is used. Thus systematic studies are needed to determine the optimal means for measuring real-world disability and its response to treatment. The present proposal has three distinct goals. It aims to determine: (1) the most accurate and practical scale for rating real-world outcomes in schizophrenia;(2) the optimal user of the scale;and (3) the factors that may impair the validity of self-reports of real-world outcomes on the part of schizophrenia patients. We adopt a construct-validation approach, using NP testing and functional-capacity measures as indicators of the construct and examining the convergence of various real-world outcome measures with these two indicators. Sophisticated data analysis will be performed to determine the convergences, and retesting will be performed to determine the test-retest stability of the candidate measures. The overall goal is to identify improved strategies for measuring real-world disability in schizophrenia and to inform the coming generation of treatment trials aimed at cognitive and functional enhancement through pharmacology and cognitive remediation in terms of the most suitable outcomes measures.

FUNDED PUBLICATIONS

  • The course of neuropsychological performance and functional capacity in older patients with schizophrenia: influences of previous history of long-term institutional stay.
  • Initial validation of a computerized version of the UCSD Performance-Based Skills Assessment (C-UPSA) for assessing functioning in schizophrenia.
  • Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder.
  • Impairment in functional capacity as an endophenotype candidate in severe mental illness.
  • Social competence versus negative symptoms as predictors of real world social functioning in schizophrenia.
  • Association of obesity and treated hypertension and diabetes with cognitive ability in bipolar disorder and schizophrenia.
  • Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder.
  • Psychometric properties of performance-based measurements of functional capacity: test-retest reliability, practice effects, and potential sensitivity to change.
  • Social competence and observer-rated social functioning in bipolar disorder.
  • Relationship of the Brief UCSD Performance-based Skills Assessment (UPSA-B) to multiple indicators of functioning in people with schizophrenia and bipolar disorder.
  • Performance-based measurement of functional disability in schizophrenia: a cross-national study in the United States and Sweden.
  • Self-assessment of functional ability in schizophrenia: milestone achievement and its relationship to accuracy of self-evaluation.
  • Factor structure of the MATRICS Consensus Cognitive Battery (MCCB) in schizophrenia.
  • Validating measures of real-world outcome: the results of the VALERO expert survey and RAND panel.
  • Sensitivity and specificity of the UCSD Performance-based Skills Assessment (UPSA-B) for identifying functional milestones in schizophrenia.
  • Asymptomatic HIV-associated neurocognitive impairment increases risk for symptomatic decline.
  • Factor structure of neurocognition and functional capacity in schizophrenia: a multidimensional examination of temporal stability.
  • Measurement of functional capacity: a new approach to understanding functional differences and real-world behavioral adaptation in those with mental illness.
  • Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures.
  • Determinants of occupational and residential functioning in bipolar disorder.
  • Functional milestones and clinician ratings of everyday functioning in people with schizophrenia: overlap between milestones and specificity of ratings.
  • Cognition assessment using the NIH Toolbox.
  • HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study.
  • Validating the measurement of real-world functional outcomes: phase I results of the VALERO study.
  • Assessing everyday functioning in schizophrenia: not all informants seem equally informative.
  • Factors influencing self-assessment of cognition and functioning in schizophrenia: implications for treatment studies.
  • Predictors of the accuracy of self assessment of everyday functioning in people with schizophrenia.
  • The convergence between self-reports and observer ratings of financial skills and direct assessment of financial capabilities in patients with schizophrenia: more detail is not always better.
  • Beyond the global assessment of functioning: learning from Virginia Apgar.
  • Abbreviated neuropsychological assessment in schizophrenia: prediction of different aspects of outcome.
  • Real-world functioning and self-evaluation of functioning: brain structure, mood state, functional skills, and mortality.
  • Current smoking is associated with worse cognitive and adaptive functioning in serious mental illness.
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