Cognitive impairments have long been known to predict everyday functioning in people with various neuropsychiatric conditions (Heaton and Pendleton, 1981) and schizophrenia is a clear example of that. While there have been multiple reviews and meta-analyses (e.g. Green et al., 2000) of the relationship between cognition and everyday functioning in schizophrenia, recent research has suggested that cognitive deficits may exert their influence on everyday functioning through their relationship with functional capacity (Bowie et al., 2008). Functional capacity refers to the ability to perform the component skills required for everyday functioning, including such things as managing money, making telephone calls, shopping, and traveling (Harvey et al., 2007). It has been found in several studies that cognitive deficits are strongly related to measures of functional capacity, which are in turn related to everyday functioning (see Leifker et al., 2011, for a review). These relationships, presented graphically in Figure 1, suggest that treatment of cognitive impairment may facilitate the chances of improved everyday functioning; moreover, they also suggest that direct improvements in functional capacity, if possible, may also improve everyday outcomes. As can be seen in the figure, of the multiple cognitive domains measured in this study (Bowie et al., 2008), only one had a direct and unmediated influence on the performance-based measures of functional capacity, in this case the UCSD performance-based skills assessment (UPSA; Patterson et al., 2001a) and the Social Skills Performance Assessment (SSPA; Patterson et al., 2001b). As impairments in everyday functioning are very common and severe in schizophrenia, reducing these deficits is critically important. Impairments in everyday functioning lead to indirect costs of schizophrenia of over $50 billion per year. Those costs are actually greater than the cost of treatment of schizophrenia. For example, the total cost for all antipsychotic treatments administered in the USA in 2010, including to patients with conditions other than schizophrenia, was about $8 billion. Thus, treatments aimed at disability reduction appear to have the potential to lead to marked cost savings to the US economy as a whole.
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