INTRODUCTION: In this study we assessed the contribution of psychopathology, including the two domains of negative symptoms (motivational deficit and expressive deficit), processing speed as an index of neurocognition, and emotion recognition, as an index of social cognition, to poor functional outcomes in people with schizophrenia. METHODS: The Positive and Negative Syndrome Scale was used to evaluate positive symptoms and disorganization and the Brief Negative Symptom Scale to assess negative symptoms. The Symbol Coding and the Trail Making Test A and B were used to rate processing speed and the Facial Emotion Identification Test to assess emotion recognition. Functional outcome was assessed with the Personal and Social Performance Scale (PSP). Regression analyses were performed to identify predictors of functional outcome. Mediation analyses was used to investigate whether social cognition and negative symptom domains fully or partially mediated the impact of processing speed on functional outcome. RESULTS: One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive deficit predicted global functioning and together with motivational deficit fully mediated the effects of neurocognition on it. Motivational deficit was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational deficit and neurocognitive impairment predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome. CONCLUSIONS: Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive deficits on different domains of functioning. Our results suggest that both negative symptoms and social cognition should be targeted by psychosocial interventions to enhance the functional impact of neurocognitive remediation.

6th Psychiatric Department Otto Wagner Spital Vienna Austria

Center for Neuropsychiatric Schizophrenia Research Mental Health Center Glostrup Glostrup Denmark

Department of Adult Psychiatry Poznan University of Medical Sciences Poznan Poland

Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Department of Psychiatry and Psychotherapy Medical University of Vienna Vienna Austria

Department of Psychiatry Charles University Faculty of Medicine and University Hospital Hradec Králové Hradec Králové Czechia

Department of Psychiatry University of Campania Luigi Vanvitelli Naples Italy

Medical University Innsbruck Department of Psychiatry Psychotherapy Psychosomatics and Medical Psychology Division of Psychiatry 1 Innsbruck Austria

NORMENT Centre Institute of Clinical Psychiatry University of Oslo and Oslo University Hospital Oslo Norway

Psychiatric Research Unit Region Zealand Psychiatry Slagelse Denmark

Zobrazit více v PubMed

GBD 2016 Disease and Injury Incidence and Prevalence Collaborators . Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London England) (2017) 390(10100):1211–59. doi: 10.1016/S0140-6736(17)32154-2 PubMed DOI PMC

Correll CU, Solmi M, Croatto G, Schneider LK, Rohani-Montez SC, Fairley L, et al. . Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry (2022) 21(2):248–71. doi: 10.1002/wps.20994 PubMed DOI PMC

Sass L. Subjectivity, psychosis and the science of psychiatry. World Psychiatry (2022) 21(2):165–6. doi: 10.1002/wps.20986 PubMed DOI PMC

Galderisi S, Rossi A, Rocca P, Bertolino A, Mucci A, Bucci P, et al. . The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry (2014) 13(3):275–87. doi: 10.1002/wps.20167 PubMed DOI PMC

Galderisi S, Rucci P, Kirkpatrick B, Mucci A, Gibertoni D, Rocca P, et al. . Interplay among psychopathologic variables, personal resources, context-related factors, and real-life functioning in individuals with schizophrenia: A network analysis. JAMA Psychiatry (2018) 75(4):396–404. doi: 10.1001/jamapsychiatry.2017.4607 PubMed DOI PMC

Galderisi S, Rucci P, Mucci A, Rossi A, Rocca P, Bertolino A, et al. . The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients. World Psychiatry (2020) 19(1):81–91. doi: 10.1002/wps.20700 PubMed DOI PMC

Rapoport JL, Giedd JN, Gogtay N. Neurodevelopmental model of schizophrenia: update 2012. Mol Psychiatry (2012) 17(12):1228–38. doi: 10.1038/mp.2012.23 PubMed DOI PMC

Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, et al. . The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry (2021) 20(1):4–33. doi: 10.1002/wps.20809 PubMed DOI PMC

Mucci A, Galderisi S, Gibertoni D, Rossi A, Rocca P, Bertolino A, et al. . Factors associated with real-life functioning in persons with schizophrenia in a 4-year follow-up study of the italian network for research on psychoses. JAMA Psychiatry (2021) 78(5):550–9. doi: 10.1001/jamapsychiatry.2020.4614 PubMed DOI PMC

Giordano GM, Bucci P, Mucci A, Pezzella P, Galderisi S. Gender differences in clinical and psychosocial features among persons with schizophrenia: A mini review. Front Psychiatry (2021) 12:789179. doi: 10.3389/fpsyt.2021.789179 PubMed DOI PMC

Watson D, Levin-Aspenson HF, Waszczuk MA, Conway CC, Dalgleish T, Dretsch MN, et al. . Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum. World Psychiatry (2022) 21(1):26–54. doi: 10.1002/wps.20943 PubMed DOI PMC

Mesholam-Gately RI, Johnston D, Keshavan MS. What's in the name "schizophrenia"? A clinical, research and lived experience perspective. World Psychiatry (2023) 22(1):156–7. doi: 10.1002/wps.21033 PubMed DOI PMC

Galderisi S. Promoting schizophrenia research in Europe: the contribution of the European Group for Research in Schizophrenia. World Psychiatry (2023) 22(3):486–7. doi: 10.1002/wps.21100 PubMed DOI PMC

Fusar-Poli P, Estradé A, Stanghellini G, Venables J, Onwumere J, Messas G, et al. . The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. World Psychiatry (2022) 21(2):168–88. doi: 10.1002/wps.20959 PubMed DOI PMC

Galderisi S, Rossi A, Rocca P, Bertolino A, Mucci A, Bucci P, et al. . Pathways to functional outcome in subjects with schizophrenia living in the community and their unaffected first-degree relatives. Schizophr Res (2016) 175(1-3):154–60. doi: 10.1016/j.schres.2016.04.043 PubMed DOI

Giordano GM, Brando F, Pezzella P, De Angelis M, Mucci A, Galderisi S. Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature. Front Psychiatry (2022) 13:970210. doi: 10.3389/fpsyt.2022.970210 PubMed DOI PMC

Harvey PD, Strassnig M. Predicting the severity of everyday functional disability in people with schizophrenia: cognitive deficits, functional capacity, symptoms, and health status. World Psychiatry (2012) 11(2):73–9. doi: 10.1016/j.wpsyc.2012.05.004 PubMed DOI PMC

Rocca P, Brasso C, Montemagni C, Bellino S, Rossi A, Bertolino A, et al. . Accuracy of self-assessment of real-life functioning in schizophrenia. NPJ Schizophrenia (2021) 7(1):11. doi: 10.1038/s41537-021-00140-9 PubMed DOI PMC

Giuliani L, Giordano GM, Bucci P, Pezzella P, Brando F, Galderisi S. Improving knowledge on pathways to functional outcome in schizophrenia: main results from the italian network for research on psychoses. Front Psychiatry (2021) 12:791117. doi: 10.3389/fpsyt.2021.791117 PubMed DOI PMC

Vita A, Barlati S, Deste G, Rocca P, Rossi A, Bertolino A, et al. . The influence of autistic symptoms on social and non-social cognition and on real-life functioning in people with schizophrenia: Evidence from the Italian Network for Research on Psychoses multicenter study. Eur Psychiatry J Assoc Eur Psychiatrists. (2020) 63(1):e98. doi: 10.1192/j.eurpsy.2020.99 PubMed DOI PMC

McDonald S, Pica S, Hayes RL, Baglioni AJ, Jr. Stress and coping in early psychosis: Role of symptoms, self-efficacy, and social support in coping with stress. Br J Psychiatry (1998) 172(S33):122–7. PubMed

Rossi A, Galderisi S, Rocca P, Bertolino A, Mucci A, Rucci P, et al. . The relationships of personal resources with symptom severity and psychosocial functioning in persons with schizophrenia: results from the Italian Network for Research on Psychoses study. Eur Arch Psychiatry Clin Neurosci (2017) 267(4):285–94. doi: 10.1007/s00406-016-0710-9 PubMed DOI

Ritsner MS, Ratner Y. The long-term changes in coping strategies in schizophrenia: temporal coping types. J Nerv Ment Dis (2006) 194(4):261–7. doi: 10.1097/01.nmd.0000207361.81947.52 PubMed DOI

Colizzi M, Cullen AE, Martland N, Di Forti M, Murray R, Schoeler T, et al. . Association between stressful life events and psychosis relapse: a 2-year prospective study in first-episode psychosis. World Psychiatry (2023) 22(1):159–60. doi: 10.1002/wps.21046 PubMed DOI PMC

Giordano GM, Galderisi S, Pezzella P, Perrottelli A, Bucci P. Determinants of clinical recovery in schizophrenia. In: Carpiniello B, Vita A, Mencacci C, editors. Recovery and major mental disorders. Cham: Springer International Publishing; (2022). p. 23–43.

Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, et al. . EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry J Assoc Eur Psychiatrists (2021) 64(1):e23. doi: 10.1192/j.eurpsy.2021.11 PubMed DOI PMC

Vita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, et al. . European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry J Assoc Eur Psychiatrists (2022) 65(1):e58. doi: 10.1192/j.eurpsy.2022.2316 PubMed DOI PMC

Galderisi S, Kaiser S, Bitter I, Nordentoft M, Mucci A, Sabé M, et al. . EPA guidance on treatment of negative symptoms in schizophrenia. Eur Psychiatry J Assoc Eur Psychiatrists. (2021) 64(1):e21. doi: 10.1192/j.eurpsy.2021.13 PubMed DOI PMC

Killaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, et al. . Community-based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence. World Psychiatry (2022) 21(1):96–123. doi: 10.1002/wps.20940 PubMed DOI PMC

Leichsenring F, Steinert C, Rabung S, Ioannidis JPA. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry (2022) 21(1):133–45. doi: 10.1002/wps.20941 PubMed DOI PMC

Ostuzzi G, Bertolini F, Tedeschi F, Vita G, Brambilla P, Del Fabro L, et al. . Oral and long-acting antipsychotics for relapse prevention in schizophrenia-spectrum disorders: a network meta-analysis of 92 randomized trials including 22,645 participants. World Psychiatry (2022) 21(2):295–307. doi: 10.1002/wps.20972 PubMed DOI PMC

Siskind D, Yung A. After the acute crisis - engaging people with psychosis in rehabilitation-oriented care. World Psychiatry (2022) 21(2):246–7. doi: 10.1002/wps.20970 PubMed DOI PMC

Vita A, Gaebel W, Mucci A, Sachs G, Barlati S, Giordano GM, et al. . European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia. Eur Psychiatry J Assoc Eur Psychiatrists. (2022) 65(1):e57. doi: 10.1192/j.eurpsy.2022.2315 PubMed DOI PMC

McCutcheon RA, Pillinger T, Efthimiou O, Maslej M, Mulsant BH, Young AH, et al. . Reappraising the variability of effects of antipsychotic medication in schizophrenia: a meta-analysis. World Psychiatry (2022) 21(2):287–94. doi: 10.1002/wps.20977 PubMed DOI PMC

Leucht S, Schneider-Thoma J, Burschinski A, Peter N, Wang D, Dong S, et al. . Long-term efficacy of antipsychotic drugs in initially acutely ill adults with schizophrenia: systematic review and network meta-analysis. World Psychiatry (2023) 22(2):315–24. doi: 10.1002/wps.21089 PubMed DOI PMC

Kern RS, Gold JM, Dickinson D, Green MF, Nuechterlein KH, Baade LE, et al. . The MCCB impairment profile for schizophrenia outpatients: results from the MATRICS psychometric and standardization study. Schizophr Res (2011) 126(1-3):124–31. doi: 10.1016/j.schres.2010.11.008 PubMed DOI PMC

Dickinson D, Ramsey ME, Gold JM. Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Arch Gen Psychiatry (2007) 64(5):532–42. doi: 10.1001/archpsyc.64.5.532 PubMed DOI

Knowles EE, David AS, Reichenberg A. Processing speed deficits in schizophrenia: reexamining the evidence. Am J Psychiatry (2010) 167(7):828–35. doi: 10.1176/appi.ajp.2010.09070937 PubMed DOI

Bosia M, Bechi M, Bosinelli F, Politi E, Buonocore M, Spangaro M, et al. . From cognitive and clinical substrates to functional profiles: Disentangling heterogeneity in schizophrenia. Psychiatry Res (2019) 271:446–53. doi: 10.1016/j.psychres.2018.12.026 PubMed DOI

Fusar-Poli P, Deste G, Smieskova R, Barlati S, Yung AR, Howes O, et al. . Cognitive functioning in prodromal psychosis: a meta-analysis. Arch Gen Psychiatry (2012) 69(6):562–71. doi: 10.1001/archgenpsychiatry.2011.1592 PubMed DOI

Gold S, Arndt S, Nopoulos P, O'Leary DS, Andreasen NC. Longitudinal study of cognitive function in first-episode and recent-onset schizophrenia. Am J Psychiatry (1999) 156(9):1342–8. doi: 10.1176/ajp.156.9.1342 PubMed DOI

Luther L, Suor JH, Rosen C, Jobe TH, Faull RN, Harrow M. Clarifying the direction of impact of negative symptoms and neurocognition on prospective work functioning in psychosis: A 20-year longitudinal study. Schizophr Res (2020) 220:232–9. doi: 10.1016/j.schres.2020.03.012 PubMed DOI PMC

Wykes T, Reeder C, Corner J. The prevalence and stability of an executive processing deficit, response inhibition, in people with chronic schizophrenia. Schizophr Res (2000) 46(2-3):241–53. doi: 10.1016/S0920-9964(99)00233-9 PubMed DOI

Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “Right stuff”? Schizophr Bull (2000) 26(1):119–36. doi: 10.1093/oxfordjournals.schbul.a033430 PubMed DOI

Green MF, Horan WP, Lee J. Nonsocial and social cognition in schizophrenia: current evidence and future directions. World Psychiatry (2019) 18(2):146–61. doi: 10.1002/wps.20624 PubMed DOI PMC

Harvey PD, Strassnig MT. Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry (2019) 18(2):165–7. doi: 10.1002/wps.20647 PubMed DOI PMC

Schmidt SJ, Mueller DR, Roder V. Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling. Schizophr Bull (2011) 37 Suppl 2(Suppl 2):S41–54. doi: 10.1093/schbul/sbr079 PubMed DOI PMC

Ventura J, Hellemann GS, Thames AD, Koellner V, Nuechterlein KH. Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res (2009) 113(2-3):189–99. doi: 10.1016/j.schres.2009.03.035 PubMed DOI PMC

Smelror RE, Rund BR, Lonning V, Jorgensen KN, Wedervang-Resell K, Andreassen OA, et al. . Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis. Eur Child Adolesc Psychiatry (2020) 29(12):1693–703. doi: 10.1007/s00787-020-01479-7 PubMed DOI PMC

Deste G, Vita A, Nibbio G, Penn DL, Pinkham AE, Harvey PD. Autistic symptoms and social cognition predict real-world outcomes in patients with schizophrenia. Front Psychiatry (2020) 11:524. doi: 10.3389/fpsyt.2020.00524 PubMed DOI PMC

Halverson TF, Orleans-Pobee M, Merritt C, Sheeran P, Fett AK, Penn DL. Pathways to functional outcomes in schizophrenia spectrum disorders: Meta-analysis of social cognitive and neurocognitive predictors. Neurosci Biobehav Rev (2019) 105:212–9. doi: 10.1016/j.neubiorev.2019.07.020 PubMed DOI

Sachs G, Steger-Wuchse D, Kryspin-Exner I, Gur RC, Katschnig H. Facial recognition deficits and cognition in schizophrenia. Schizophr Res (2004) 68(1):27–35. doi: 10.1016/S0920-9964(03)00131-2 PubMed DOI

Sachs G, Winklbaur B, Jagsch R, Lasser I, Kryspin-Exner I, Frommann N, et al. . Training of affect recognition (TAR) in schizophrenia–impact on functional outcome. Schizophr Res (2012) 138(2-3):262–7. doi: 10.1016/j.schres.2012.03.005 PubMed DOI

Glenthøj LB, Albert N, Fagerlund B, Kristensen TD, Wenneberg C, Hjorthøj C, et al. . Emotion recognition latency, but not accuracy, relates to real life functioning in individuals at ultra-high risk for psychosis. Schizophr Res (2019) 210:197–202. doi: 10.1016/j.schres.2018.12.038 PubMed DOI

Pinkham AE, Penn DL, Green MF, Buck B, Healey K, Harvey PD. The social cognition psychometric evaluation study: results of the expert survey and RAND panel. Schizophr Bull (2014) 40(4):813–23. doi: 10.1093/schbul/sbt081 PubMed DOI PMC

Green MF, Bearden CE, Cannon TD, Fiske AP, Hellemann GS, Horan WP, et al. . Social cognition in schizophrenia, Part 1: performance across phase of illness. Schizophr Bull (2012) 38(4):854–64. doi: 10.1093/schbul/sbq171 PubMed DOI PMC

Horan WP, Green MF, DeGroot M, Fiske A, Hellemann G, Kee K, et al. . Social cognition in schizophrenia, Part 2: 12-month stability and prediction of functional outcome in first-episode patients. Schizophr Bull (2012) 38(4):865–72. doi: 10.1093/schbul/sbr001 PubMed DOI PMC

Corcoran CM, Keilp JG, Kayser J, Klim C, Butler PD, Bruder GE, et al. . Emotion recognition deficits as predictors of transition in individuals at clinical high risk for schizophrenia: a neurodevelopmental perspective. Psychol Med (2015) 45(14):2959–73. doi: 10.1017/S0033291715000902 PubMed DOI PMC

Fett AK, Viechtbauer W, Dominguez MD, Penn DL, van Os J, Krabbendam L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev (2011) 35(3):573–88. doi: 10.1016/j.neubiorev.2010.07.001 PubMed DOI

Irani F, Seligman S, Kamath V, Kohler C, Gur RC. A meta-analysis of emotion perception and functional outcomes in schizophrenia. Schizophr Res (2012) 137(1-3):203–11. doi: 10.1016/j.schres.2012.01.023 PubMed DOI PMC

Addington J, Saeedi H, Addington D. Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. Br J Psychiatry J Ment science. (2006) 189:373–8. doi: 10.1192/bjp.bp.105.021022 PubMed DOI

Ventura J. Computer-based virtual reality assessment of functional capacity in primary psychosis. World Psychiatry (2022) 21(3):464–5. doi: 10.1002/wps.21024 PubMed DOI PMC

Couture SM, Penn DL, Roberts DL. The functional significance of social cognition in schizophrenia: a review. Schizophr Bull (2006) 32 Suppl 1(Suppl 1):S44–63. doi: 10.1093/schbul/sbl029 PubMed DOI PMC

González-Ortega I, González-Pinto A, Alberich S, Echeburúa E, Bernardo M, Cabrera B, et al. . Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis. Psychol Med (2020) 50(16):2702–10. doi: 10.1017/S0033291719002794 PubMed DOI

Ruiz-Toca A, Fernández-Aragón C, Madrigal A, Halverson T, Rodríguez-Jiménez R, Lahera G. Social cognition mediates the impact of processing speed and sustained attention on global functioning in schizophrenia. Psicothema. (2023) 35(1):87–97. doi: 10.7334/psicothema2022.8 PubMed DOI

Sergi MJ, Rassovsky Y, Nuechterlein KH, Green MF. Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. Am J Psychiatry (2006) 163(3):448–54. doi: 10.1176/appi.ajp.163.3.448 PubMed DOI

Uchino T, Okubo R, Takubo Y, Aoki A, Wada I, Hashimoto N, et al. . Mediation effects of social cognition on the relationship between neurocognition and social functioning in major depressive disorder and schizophrenia spectrum disorders. J Personalized Med (2023) 13(4):683. doi: 10.3390/jpm13040683 PubMed DOI PMC

Addington J, Saeedi H, Addington D. Facial affect recognition: a mediator between cognitive and social functioning in psychosis? Schizophr Res (2006) 85(1-3):142–50. doi: 10.1016/j.schres.2006.03.028 PubMed DOI

Giordano GM, Caporusso E, Pezzella P, Galderisi S. Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia. Expert Rev Neurotherapeutics (2022) 22(7):541–55. doi: 10.1080/14737175.2022.2092402 PubMed DOI

Starzer M, Hansen HG, Hjorthøj C, Albert N, Nordentoft M, Madsen T. 20-year trajectories of positive and negative symptoms after the first psychotic episode in patients with schizophrenia spectrum disorder: results from the OPUS study. World Psychiatry (2023) 22(3):424–32. doi: 10.1002/wps.21121 PubMed DOI PMC

Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. World Psychiatry (2017) 16(1):14–24. doi: 10.1002/wps.20385 PubMed DOI PMC

Rocca P, Montemagni C, Zappia S, Pitera R, Sigaudo M, Bogetto F. Negative symptoms and everyday functioning in schizophrenia: a cross-sectional study in a real world-setting. Psychiatry Res (2014) 218(3):284–9. doi: 10.1016/j.psychres.2014.04.018 PubMed DOI

Moura BM, Isvoranu AM, Kovacs V, Van Rooijen G, Van Amelsvoort T, Simons CJP, et al. . The puzzle of functional recovery in schizophrenia-spectrum disorders-replicating a network analysis study. Schizophr Bull (2022) 48(4):871–80. doi: 10.1093/schbul/sbac018 PubMed DOI PMC

Lee EHM, Hui CLM, Chan KPK, Chan PY, Law EYL, Chong CSY, et al. . The role of symptoms and insight in mediating cognition and functioning in first episode psychosis. Schizophr Res (2019) 206:251–6. doi: 10.1016/j.schres.2018.11.009 PubMed DOI

Lin CH, Huang CL, Chang YC, Chen PW, Lin CY, Tsai GE, et al. . Clinical symptoms, mainly negative symptoms, mediate the influence of neurocognition and social cognition on functional outcome of schizophrenia. Schizophr Res (2013) 146(1-3):231–7. doi: 10.1016/j.schres.2013.02.009 PubMed DOI

Glenthøj LB, Jepsen JR, Hjorthøj C, Bak N, Kristensen TD, Wenneberg C, et al. . Negative symptoms mediate the relationship between neurocognition and function in individuals at ultrahigh risk for psychosis. Acta psychiatrica Scandinavica (2017) 135(3):250–8. doi: 10.1111/acps.12682 PubMed DOI

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull (1987) 13(2):261–76. doi: 10.1093/schbul/13.2.261 PubMed DOI

Wallwork RS, Fortgang R, Hashimoto R, Weinberger DR, Dickinson D. Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophr Res (2012) 137(1-3):246–50. doi: 10.1016/j.schres.2012.01.031 PubMed DOI PMC

Kirkpatrick B, Strauss GP, Nguyen L, Fischer BA, Daniel DG, Cienfuegos A, et al. . The brief negative symptom scale: psychometric properties. Schizophr Bull (2011) 37(2):300–5. doi: 10.1093/schbul/sbq059 PubMed DOI PMC

Kirkpatrick B, Fenton WS, Carpenter WT, Jr., Marder SR. The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull (2006) 32(2):214–9. doi: 10.1093/schbul/sbj053 PubMed DOI PMC

Mucci A, Galderisi S, Merlotti E, Rossi A, Rocca P, Bucci P, et al. . The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia. Eur Psychiatry J Assoc Eur Psychiatrists (2015) 30(5):641–7. doi: 10.1016/j.eurpsy.2015.01.014 PubMed DOI

Karbasforoushan H, Duffy B, Blackford JU, Woodward ND. Processing speed impairment in schizophrenia is mediated by white matter integrity. Psychol Med (2015) 45(1):109–20. doi: 10.1017/S0033291714001111 PubMed DOI PMC

Keefe RS, Goldberg TE, Harvey PD, Gold JM, Poe MP, Coughenour L. The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res (2004) 68(2-3):283–97. doi: 10.1016/j.schres.2003.09.011 PubMed DOI

Sachs G, Winklbaur B, Jagsch R, Keefe RS. Validation of the German version of the brief assessment of cognition in Schizophrenia (BACS) - preliminary results. Eur Psychiatry J Assoc Eur Psychiatrists (2011) 26(2):74–7. doi: 10.1016/j.eurpsy.2009.10.006 PubMed DOI

Kerr SL, Neale JM. Emotion perception in schizophrenia: specific deficit or further evidence of generalized poor performance? J Abnormal Psychol (1993) 102(2):312–8. doi: 10.1037/0021-843X.102.2.312 PubMed DOI

Nasrallah H, Morosini P, Gagnon DD. Reliability, validity and ability to detect change of the Personal and Social Performance scale in patients with stable schizophrenia. Psychiatry Res (2008) 161(2):213–24. doi: 10.1016/j.psychres.2007.11.012 PubMed DOI

Bowie CR, Leung WW, Reichenberg A, McClure MM, Patterson TL, Heaton RK, et al. . Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry (2008) 63(5):505–11. doi: 10.1016/j.biopsych.2007.05.022 PubMed DOI PMC

Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD. Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry (2006) 163(3):418–25. doi: 10.1176/appi.ajp.163.3.418 PubMed DOI

Leifker FR, Bowie CR, Harvey PD. Determinants of everyday outcomes in schizophrenia: the influences of cognitive impairment, functional capacity, and symptoms. Schizophr Res (2009) 115(1):82–7. doi: 10.1016/j.schres.2009.09.004 PubMed DOI

García-Portilla MP, García-Álvarez L, González-Blanco L, Dal Santo F, Bobes-Bascarán T, Martínez-Cao C, et al. . Real-world functioning in patients with schizophrenia: beyond negative and cognitive symptoms. Front Psychiatry (2021) 12:700747. doi: 10.3389/fpsyt.2021.700747 PubMed DOI PMC

Meyer EC, Carrión RE, Cornblatt BA, Addington J, Cadenhead KS, Cannon TD, et al. . The relationship of neurocognition and negative symptoms to social and role functioning over time in individuals at clinical high risk in the first phase of the North American Prodrome Longitudinal Study. Schizophr Bull (2014) 40(6):1452–61. doi: 10.1093/schbul/sbt235 PubMed DOI PMC

Nakagami E, Xie B, Hoe M, Brekke JS. Intrinsic motivation, neurocognition and psychosocial functioning in schizophrenia: testing mediator and moderator effects. Schizophr Res (2008) 105(1-3):95–104. doi: 10.1016/j.schres.2008.06.015 PubMed DOI

Brittain P, Ffytche DH, McKendrick A, Surguladze S. Visual processing, social cognition and functional outcome in schizophrenia. Psychiatry Res (2010) 178(2):270–5. doi: 10.1016/j.psychres.2009.09.013 PubMed DOI

Horton HK, Silverstein SM. Social cognition as a mediator of cognition and outcome among deaf and hearing people with schizophrenia. Schizophr Res (2008) 105(1):125–37. doi: 10.1016/j.schres.2008.07.003 PubMed DOI

Rassovsky Y, Horan WP, Lee J, Sergi MJ, Green MF. Pathways between early visual processing and functional outcome in schizophrenia. Psychol Med (2011) 41(3):487–97. doi: 10.1017/S0033291710001054 PubMed DOI PMC

Sergi MJ, Rassovsky Y, Nuechterlein KH, Green MF. Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. Am J Psychiatry (2006) 163(3):448–54. doi: 10.1176/appi.ajp.163.3.448 PubMed DOI

Ayesa-Arriola R, Setién-Suero E, Neergaard KD, Ferro A, Fatjó-Vilas M, Ríos-Lago M, et al. . Evidence for trait related theory of mind impairment in first episode psychosis patients and its relationship with processing speed: A 3 year follow-up study. Front Psychol (2016) 7:592. doi: 10.3389/fpsyg.2016.00592 PubMed DOI PMC

Tsotsi S, Bozikas VP, Kosmidis MH. The role of attention processes in facial affect recognition in schizophrenia. Cogn Neuropsychiatry (2015) 20(6):526–41. doi: 10.1080/13546805.2015.1110517 PubMed DOI

Andrade-González N, Sarasa M, García-López A, Leonés I, Halverson TF, Lahera G. Mentalizing errors in patients with schizophrenia who received psychosocial rehabilitation: a case-control study. Psychiatr Quarterly (2021) 92(3):947–59. doi: 10.1007/s11126-020-09863-x PubMed DOI

Thibaudeau É, Achim AM, Parent C, Turcotte M, Cellard C. A meta-analysis of the associations between theory of mind and neurocognition in schizophrenia. Schizophr Res (2020) 216:118–28. doi: 10.1016/j.schres.2019.12.017 PubMed DOI

Catalan A, Angosto V, Díaz A, Martínez N, Guede D, Pereda M, et al. . The relationship between theory of mind deficits and neurocognition in first episode-psychosis. Psychiatry Res (2018) 268:361–7. doi: 10.1016/j.psychres.2018.06.066 PubMed DOI

Sjølie C, Meyn EK, Raudeberg R, Andreassen OA, Vaskinn A. Nonsocial cognitive underpinnings of theory of mind in schizophrenia. Psychiatry Res (2020) 289:113055. doi: 10.1016/j.psychres.2020.113055 PubMed DOI

Grant N, Lawrence M, Preti A, Wykes T, Cella M. Social cognition interventions for people with schizophrenia: a systematic review focussing on methodological quality and intervention modality. Clin Psychol Review (2017) 56:55–64. doi: 10.1016/j.cpr.2017.06.001 PubMed DOI

Kurtz MM, Gagen E, Rocha NBF, MaChado S, Penn DL. Comprehensive treatments for social cognitive deficits in schizophrenia: A critical review and effect-size analysis of controlled studies. Clin Psychol Review (2016) 43:80–9. doi: 10.1016/j.cpr.2015.09.003 PubMed DOI

Pinkham AE, Penn DL. Neurocognitive and social cognitive predictors of interpersonal skill in schizophrenia. Psychiatry Res (2006) 143(2):167–78. doi: 10.1016/j.psychres.2005.09.005 PubMed DOI

Sachs G, Lasser I, Purdon SE, Erfurth A. Screening for cognitive impairment in schizophrenia: Psychometric properties of the German version of the Screen for Cognitive Impairment in Psychiatry (SCIP-G). Schizophr Res Cognition. (2021) 25:100197. doi: 10.1016/j.scog.2021.100197 PubMed DOI PMC

Schaefer J, Giangrande E, Weinberger DR, Dickinson D. The global cognitive impairment in schizophrenia: Consistent over decades and around the world. Schizophr Res (2013) 150(1):42–50. doi: 10.1016/j.schres.2013.07.009 PubMed DOI PMC

Kohler CG, Walker JB, Martin EA, Healey KM, Moberg PJ. Facial emotion perception in schizophrenia: A meta-analytic review. Schizophr Bulletin (2009) 36(5):1009–19. doi: 10.1093/schbul/sbn192 PubMed DOI PMC

Emsley R, Dunn G, White IR. Mediation and moderation of treatment effects in randomised controlled trials of complex interventions. Stat Methods Med Res (2010) 19(3):237–70. doi: 10.1177/0962280209105014 PubMed DOI

MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu Rev Psychol (2007) 58:593–614. doi: 10.1146/annurev.psych.58.110405.085542 PubMed DOI PMC

Keshavan MS, Eack SM. Cognitive enhancement interventions are effective for schizophrenia: why not provide them early? World Psychiatry (2023) 22(2):326–7. doi: 10.1002/wps.21091 PubMed DOI PMC

Schäfer SK, Thomas LM, Lindner S, Lieb K. World Health Organization's low-intensity psychosocial interventions: a systematic review and meta-analysis of the effects of Problem Management Plus and Step-by-Step. World Psychiatry (2023) 22(3):449–62. doi: 10.1002/wps.21129 PubMed DOI PMC

Brady LS, Larrauri CA. Accelerating Medicines Partnership(®) Schizophrenia (AMP(®) SCZ): developing tools to enable early intervention in the psychosis high risk state. World Psychiatry (2023) 22(1):42–3. doi: 10.1002/wps.21038 PubMed DOI PMC