Clinical Instruments to Evaluate and Guide Treatment in Schizophrenia
Treatment research in schizophrenia is focused on the development of pharmacological agents that are effective for improving community functioning and decreasing disability. As a result of this recent focus, there has been substantial activity for developing instruments that can measure functioning as well as the psychopathological domains that are related to functioning. Issues in selecting measures of real-world functioning include ensuring that the instrument measures the full range of possible outcomes and differentiating symptoms from functioning. For many treatment studies it is unrealistic to expect a change in actual functioning. Most treatment trials are too brief to permit subjects to change their level of vocational or social functioning. In addition, real-world functioning is influenced by factors such as an individual’s financial status or the availability of community services. This has led to the use of functional capacity measures which monitor an individual’s ability to perform functionally meaningful tasks even if they do not complete these tasks. Attention has also focused on interview-based measures of cognition and negative symptoms. Both of these psychopathological domains are related to functioning and both are the focus of drug development.
Recent drug development has focused on the development of agents that target domains of psychopathology that may lead to improved functioning. This focus contrasts with the development of first and second-generation antipsychotics; these drugs were considered effective when they treated psychotic symptoms such as auditory hallucinations, suspiciousness, delusions, and disorganized behaviors. Treating these symptoms was important for reducing suffering and for allowing many patients to live in their communities. On the other hand, these agents had relatively modest effects on the ability of patients to function in their communities. This new focus on functioning has led to the development of new instruments for measuring functioning as well as the psychopathological domains that appear to be related to impaired functioning. This review will discuss the challenges that instrument developers have faced in designing these new instruments as well as the current state of the field. The measurement of typical psychopathology—particularly psychosis will not be discussed. The measurement of cognition and social cognition is discussed in the review by Keefe and Harvey (2012) Cognitive deficits in schizophrenia. In: Geyer MA, Gross G, Eds. In: Novel antischizophrenia treatments. Handbook of experimental pharmacology. Springer, Heidelberg.
KeywordsSchizophrenia Functional outcome Disability Cognition Negative symptoms
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