1. Cognitive Remediation
Christopher R. Bowie, Ph.D., C.Psych.
Associate Professor
Psychology & Psychiatry
Queen’s University
Kingston, ON
Head Consulting Psychologist
Head’s Up Early Psychosis Program
Independent Scientist
Centre for Addiction and Mental Health
Toronto, ON

2. Functional Recovery in Schizophrenia: Historical Pessimism
Kraepelin
DSM-III: “a complete return to premorbid levels of functioning…is so rare as to cast doubt upon the accuracy of the diagnosis”
DSM-IV:TR “Complete remission is probably not common”
For many, a return to premorbid levels would not be considered good fx outcome

3. Proposed Criteria for Recovery
Sustained remission of psychotic Sx
At least part-time engagement in instrumental role (worker, student, volunteer)
Living independently and handling all aspects of daily living
Participating in an active friendship or other recreational interests
Adapted from Liberman et al, 2002

4. Outcome in the Hillside First Episode Study
Adapted from Robinson et al., 1999; Robinson et al., 2002

5. ISoS Results: Remission versus Recovery ≥ 15y
No Psychosis
No Psychosis & Live Independently & Socializing
No Psychosis & Live Independently & Socializing & Working
No Psychosis & Live Independently
Even those studies that have reported
Adapted from ISOS

6. Number of Inpatient Psychiatric Beds per 100,000 Civilians
Also very much due to environmental factors.
As the wave of what has been called deinstituti…new treatment needs emerged. Ind living, community fx, work

7. Functional Assessment Domains and their Limitations
Objective information
Availability; Relevance; low rate of occurrence
Self-report
Bias; Cognitive limitations
Observation
Situation-specificity of behavior
Performance-based
Practicality; content validity

8. What predicts (in)accurate clinician ratings of cognition
What predicts (in)accurate clinician ratings of cognition? Harvey et al, 2001
Should we just ask clients?

9. Functional Assessment: Why not just ask?
Convergence of Participant and Case Manager Ratings
Pearson’s r
dunning
Bowie et al, J Psychiatric Research, 2007

10. Sadder…but Wiser Total Score Z-Score
Bowie et al, J Psychiatric Research, 2007

11. Cognitive Complaints in BPD
Self-reports were not significantly correlated with any of the objective measures.
Relationship between self-reports and mood with ↑ cognitive complaints with depression and ↓ cognitive complaints with mania.
Burdick et al. 2005

12. Description of Functional Capacity Measures
Performance of skilled acts associated with independent, community living
Directly measurable and objective
Proxy for adaptive community behavior
Most common instrument ranges from 10 minutes (UPSA-Brief) to 25 minutes (UPSA)
Newer, computerized measures entering the literature

13. Performance-Based Measures Balancing Merits & Issues
Mediate the cognition –functioning relationship
Easy to administer, well tolerated
Very good psychometric properties (comparable to cognition)
Superior to cognition for predicting independent living and work
Indirect relationship to cognitive change
Issues with cultural adaptability?*
Intrapersonal, Interpersonal, and Extrapersonal factors limit the relationship with actual community functioning
No direct assessment of work*
*As considered by expert opinion; note that several other studies have found nearly identical correlations with the UPSA and cognition and the UPSA and indicators of disability