Schizophrenia, deafness, and functional outcome: The role of neurocognition and social cognition

Recent research has highlighted the importance of cognitive factors to functional outcome among adults with schizophrenia. This study aimed to replicate and extend this work by examining the relationship between neurocognition and functional outcome among deaf adults with schizophrenia compared to their hearing counterparts. Sixty-five people with schizophrenia were assessed using measures of memory, attention, visual processing, facial-affect processing, and theory of mind. Neurocognitive variables were used to predict the dependent variable, functional outcome, which was operationalized by a measure that assessed adaptive behaviors that influence community living (e.g., response to stress and anxiety, ability to manage money).; Descriptive analyses indicated that deaf and hearing subjects exhibit similar deficits in neurocognition and social cognition. However, hearing status appeared to moderate certain relationships between neurocognitive factors and functional outcome. For example, verbal memory was the strongest predictor of functional outcome for hearing subjects while linguistic ability was the strongest predictor for deaf subjects.; The results suggest that neurocognition exerted an effect on functional outcome indirectly through its influence on social cognition. The patterns of mediation varied when the samples were broken down by hearing status and analyzed separately. Namely, the ability to infer another person's intentions (i.e., theory of mind) served as a potent mediator of neurocognition and outcome for hearing subjects only. In contrast, facial-affect processing was a significant mediator of the relationship between neurocognition and outcome for both deaf and hearing subjects. More research is necessary to determine the ways in which theory of mind plays a role in the functioning of different subgroups of people with schizophrenia.; The data from this dissertation research indicates that the development of cognitive rehabilitation strategies should include not only interventions targeting specific neurocognitive abilities, but should include an emphasis on social-cognitive domains, including facial-affect processing and theory of mind. Further, deaf and hearing subjects may benefit from interventions that address different aspects of social cognition. As treatment interventions for schizophrenia evolve, cognitive rehabilitation should be part of an intensive, structured, and comprehensive rehabilitation program.