New Research Links Cognitive Factors to Daily Functioning in Schizophrenia

Significant differences were observed between the schizophrenia and control groups across multiple neurocognitive measures. The patient group had markedly lower scores in the m-TTT concerning complexity, creation process, and overall performance.

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A recent study using the modified Tinkertoy Test (m-TTT) has expanded the understanding of specific cognitive deficits affecting life skills in individuals with schizophrenia, revealing a critical link between divergent thinking (DT) and daily functioning.¹ The study, published in Psychiatry and Clinical Neurosciences Reports, examined the relationship between life skills, divergent thinking, and various psychological assessments in patients with schizophrenia.

“Managing a complex chronic condition [such as] schizophrenia can require managing multiple medications or appointments with several specialists and this can be challenging,” Carlos Alberto Larrauri, JD, MPA, MSN, Michigan Law Review, said in an AJMC® Peer Exchange.² “And if someone has cognitive impairments, it can affect their ability to manage their overall mental health.”

Despite the impact on the lives of these patients, the specific cognitive deficits contributing to a decline in life skills have not been thoroughly investigated. Investigators aimed to address this gap by using m-TTT to evaluate 52 patients with schizophrenia and a control group matched for sex, age, and education.¹

Several psychological assessment tools were administered to evaluate the cognitive and functional abilities of the participants. The Life Skills Profile (LSP) and the Positive and Negative Syndrome Scale (PANSS) measured the functional abilities and psychiatric symptoms of the patient group. Additionally, the duration of the disease and daily antipsychotic dosage levels were assessed. Both groups were evaluated using the m-TTT, Idea Fluency Test (IFT), Design Fluency Test (DFT), and the Brief Assessment of Cognition in Schizophrenia (BACS) to provide a comprehensive overview of their cognitive functions. A stepwise multiple regression model identified significant correlates of the LSP total score among the patient group.

The findings revealed that the schizophrenia group scored significantly lower than the control group on the m-TTT, IFT, DFT, and BACS, indicating notable cognitive deficits. The regression analysis showed that the LSP total score was significantly correlated with both the m-TTT total score and the presence of negative symptoms. This suggests that DT—a cognitive process essential for generating creative ideas and solutions—plays a crucial role in the life skills of individuals with schizophrenia.

The study provided a detailed overview of the psychopathological and functional profiles of patients, as measured by the PANSS and LSP. The mean PANSS subscale scores for the patient group were 18.6 (SD, 4.9) for positive symptoms, 18.1 (4.4) for negative symptoms, and 37.2 (6.6) for general psychopathology, indicating moderate levels of symptoms. The LSP total score averaged 127.1 (11.0), with subscale scores reflecting various aspects of daily functioning: self-care, 29.4 (4.2); nonturbulence, 44.9 (3.3); social contact, 14.9 (3.3); communication, 20.0 (2.2); and responsibility, 17.8 (2.1).

Significant differences were observed between the schizophrenia and control groups across multiple neurocognitive measures. The patient group had markedly lower scores in the m-TTT concerning complexity, creation process, and overall performance (P < .001). While the IFT showed no significant differences in task-independent scores between the groups, the patient group scored lower in task-dependent and task-modified scores (P < .001). Similarly, when analyzing how deficits in DT affect life skills, Higher m-TTT scores, reflecting better DT, were associated with better life skills, while fewer negative symptoms also correlated with improved life skills. The BACS also revealed substantial reductions in composite scores for the patient group (P < .001).

The investigators concluded that life skills in individuals with schizophrenia are significantly influenced by their cognitive abilities and symptom severity. Overall, higher performance on cognitive tests was associated with better life skills. Conversely, greater severity of negative and general psychopathological symptoms was linked to poorer life skills. Stepwise regression analysis indicated that the m-TTT total score and PANSS Negative Symptoms score are key predictors of life skills, underscoring the importance of cognitive function and symptom management in enhancing daily living capabilities for schizophrenia patients.

“In our study, the m-TTT and other DT tests demonstrated a diminished capacity for DT in individuals with schizophrenia compared to the neurotypical controls,” the investigators wrote. “Additionally, the m-TTT scores and negative symptoms of schizophrenia were identified as significant factors affecting the overall LSP score. These findings underscore the pivotal role of DT in improving life skills in patients with schizophrenia. Interventions targeting these cognitive functions can enhance community adaptation skills.”

References

1. Nakamura Y, Miyamoto R, Koreki A, Anamizu S, Mimura M. Divergent thinking as a predictor of life skills in patients with schizophrenia: evidence from the modified Tinkertoy Test. Psychiatry Clin Neurosci Rep. 2024;3:e222. https://doi.org/10.1002/pcn5.222

2. AJMC® Peer Exchange. Barriers to appropriate care for patients diagnosed with schizophrenia. Managing Patients with Schizophrenia: Provider and Payer Considerations. Published August 10, 2023. Accessed July 16, 2024. https://www.ajmc.com/view/barriers-to-appropriate-care-for-patients-diagnosed-with-schizophrenia