Cognition and disability in schizophrenia: cognition‐related skills deficits and decision‐making challenges add to morbidity
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Schizophrenia contributes 13.4 (95% UI: 9.9-16.7) million years of life lived with disability to the global burden of disease. Its societal costs are immense, with costs derived from productivity loss even larger than direct treatment costs, a pattern observed across different countries and health care systems. Based on these data, disability reduction in schizophrenia is a priority, yet there are few effective treatments available. Nonsocial and social cognitive impairment contributes substantially to reductions in everyday functioning and subjective quality of life in persons with schizophrenia. Green et al1 present and evaluate sophisticated models of the influence of nonsocial and social cognition on functioning, considering moderating variables (e.g., defeatist attitudes, motivation, reward sensitivity) as well as neurobiological correlates and their potential implications. Further, they thoroughly evaluate treatment efforts to date for these deficits, including pharmacological and remediation-based approaches. Among these efforts are exercise interventions, which target physical fitness and have been shown to have beneficial effects on cognitive performance. Just like with any other chronic disease process, there are multiple factors that contribute to the development of disability in schizophrenia. Obesity and health-related comorbidities are common. Physical fitness is visibly impaired. The presence of these elements shows a correlation with cognitive impairments2. One of the issues covered in less detail in Green et al's review is that of functional capacity (the ability to perform everyday functional skills) and its potential mediating effect between nonsocial and social cognition and functional outcomes. In several studies, functional capacity was found to be proximally related to impairments in everyday functioning, with the strongest predictor of deficits in this capacity generally being nonsocial cognition. In addition, when social functional capacity, generally referred to as social competence, is examined for its relationship to functional outcomes, it can be shown that some elements of social cognition predict performance on measures of social competence, which in turn predict informant ratings of everyday social functioning. Thus, impairments in nonsocial and social cognition may be a precursor to functional skills deficits, which then in turn predict impaired everyday outcomes across several domains. In a related vein, we have recently documented that correlates of poor physical health and fitness are important determinants of disability in schizophrenia that interact with nonsocial and social cognition to complicate functional outcomes. The end result of these physical impairments might prevent people from even leaving their residences and may exacerbate limitations in functional capacity beyond those originating from nonsocial and social cognitive deficits, while generating additional roadblocks to effective deployment of everyday skills that the patients might possess. We developed a model that integrates these different contributory paths into a unified model of disability in schizophrenia, attempting to isolate the pertinent individual factors (for example, symptoms, cognition, physical functioning) and their interactions, so that they can be approached in a synergistic manner3. In analyses of data from the Suffolk County Mental Health Project, we examined the 20-year course of weight gain and its impact on everyday functioning at the 20-year follow-up. We found that weight gain was progressive over the entire period, leading to over 50% of bipolar patients and 60% of schizophrenia patients having a body mass index in the obese range 20 years after diagnosis4, a striking change from 8% and 20%, respectively, at the time of first diagnosis. In a separate examination of the everyday functioning of these same patients at the 20-year follow-up, we found that schizophrenia patients, who had a greater prevalence of obesity and worse cognitive performance, also had worse everyday functioning outcomes in terms of sustaining competitive employment and living independently5. For both patient samples, cognitive impairment and two indicators of physical functioning, waist circumference and the ability to rapidly and repeatedly rise from a chair (chair stands), were associated with competitive employment. When a logistic regression was used to predict employment, diagnosis accounted for 11% of the variance, with chair stands accounting for 9% and negative symptoms for an additional 5%. The diagnostic effect was likely associated with cognitive differences between the groups, but mobility limitations associated with obesity were excellent predictors of work outcomes. Modeling residential independence, only diagnosis accounted for variance in outcomes. These findings do not cast any doubt on the importance of cognitive impairments for predictions of everyday outcomes. Rather, they likely suggest th
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It is likely that only patients with high level of personal functioning and less severe symptomatology can use these support tools, gaining a positive reinforcement.
“Therefore, it is likely that only patients with high level of personal functioning and less severe symptomatology can use these support tools, gaining a positive reinforcement [59, 60]”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [59]
The use of apps requires specific skills.
“but it must be considered that the use of apps requires specific skills”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [59]
The introduction of specific smartphone apps has led to the dissemination of a SDM protocol.
“The introduction of specific smartphone apps has led to the dissemination of a SDM protocol”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [59]
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Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., Probst, M., Ward, P. B., Gaughran, F., De Hert, M., et al. (2017) · World Psychiatry · doi:10.1002/wps.20458 · Cited by 957 · see citing works
Nonsocial and social cognition in schizophrenia: current evidence and future directions
Green, M. F., Horan, W. P., & Lee, J. (2019) · World Psychiatry · doi:10.1002/wps.20624 · Cited by 612 · see citing works
Household availability of ultra-processed foods and obesity in nineteen European countries
Monteiro, C. A., Moubarac, J., Levy, R. B., Canella, D. S., Louzada, M. L. D. C., & Cannon, G. (2017) · Public Health Nutrition · doi:10.1017/s1368980017001379 · Cited by 578 · see citing works
Harvey, P. D., & STRASSING, M. (2012) · World Psychiatry · doi:10.1016/j.wpsyc.2012.05.004 · Cited by 363 · see citing works
Self-citationBora, E., Akdede, B. B., & Alptekin, K. (2017) · Psychological Medicine · doi:10.1017/s0033291716003366 · Cited by 219 · see citing works
Assessment of executive dysfunction during activities of daily living in schizophrenia
Semkovska, M., Bédard, M., Godbout, L., Limoge, F., & Stip, É. (2003) · Schizophrenia Research · doi:10.1016/j.schres.2003.07.005 · Cited by 154 · see citing works
Strassnig, M., Kotov, R., Cornacchio, D., Fochtmann, L. J., Harvey, P. D., & Bromet, E. J. (2017) · Bipolar Disorders · doi:10.1111/bdi.12505 · Cited by 69 · see citing works
Self-citationStrassnig, M., Cornacchio, D., Harvey, P. D., Kotov, R., Fochtmann, L. J., & Bromet, E. J. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.07.011 · Cited by 35 · see citing works
Self-citationCognition in schizophrenia: a marker of underlying neurodevelopmental problems?
Melle, I. S. (2019) · World Psychiatry · doi:10.1002/wps.20646 · Cited by 30 · see citing works
Cognitive deficits, obesity and disability in schizophrenia
Strassnig, M., Cáceda, R., Newcomer, J. W., & Harvey, P. D. (2012) · Translational Neuroscience · doi:10.2478/s13380-012-0046-5 · Cited by 14 · see citing works
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Research works printed but not linked: 18
- Green MF, Horan WP, Lee J. World Psychiatry 2019;18:146-61.
- Le Hellard S, Wang Y, Witoelar A et al. Schizophr Bull 2017;43:654-64.
- Savage JE, Jansen PR, Stringer S et al. Nat Genet 2018;50:912-9.
- McCarthy NS, Badcock JC, Clark ML et al. Schizophr Bull 2018;44:908-21.
- Kendler KS, Ohlsson H, Mezuk B et al. JAMA Psychiatry 2016;7:465-71.
- Sellgren CM, Gracias J, Watmuff B et al. Nat Neurosci 2019;22:374-85.
- Donohoe G, Holland J, Mothersill D et al. Psy- chol Med 2018;48:1608-15.
- Mollon J, Reichenberg A. Psychol Med 2018; 48:392-403.
- Carrion RE, Walder DJ, Auther AM et al. J Psy- chiatr Res 2018;96:231-8.
- Green MF, Horan WP, Lee J. World Psychiatry 2019;18:146-61.
- Bora E, Akdede BB, Alptekin K. Psychol Med 2017;47:1030-40.
- Harvey PD, Strassnig MT. World Psychiatry 2012;11:73-9.
- Strassnig MT, Kotov R, Cornacchio D et al. Bipolar Disord 2017;19:336-43.
- Strassnig MT, Cornacchio D, Harvey PD et al. J Psychiatr Res 2017;94:180-5.
- Strassnig MT, Caceda R, Newcomer JW et al. Trans Neurosci 2012;3:345-54.
- Monteiro CA, Moubarac JC, Levy RB et al. Pub- lic Health Nutr 2018;21:18-26.
- Vancampfort D, Firth J, Schuch FB et al. World Psychiatry 2017;16:308-15.
- Semkovska M, Bédard MA, Godbout L et al. Schizophr Res 2004;69:289-300. DOI:10.1002/wps.20647
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Fiorillo, A., Barlati, S., Bellomo, A., Corrivetti, G., Nicolò, G., Sampogna, G., Stanga, V., Veltro, F., Maina, G., & Vita, A. (2020) · Annals of General Psychiatry · doi:10.1186/s12991-020-00293-4 · Cited by 110 · see citing works
Strassnig, M., Harvey, P. D., Miller, M., Depp, C. A., & Granholm, E. L. (2020) · Mental health and physical activity · doi:10.1016/j.mhpa.2020.100364 · Cited by 40 · see citing works
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Luciano, M., Sampogna, G., Vecchio, V. D., Giallonardo, V., Palummo, C., Andriola, I., Amore, M., Rossi, R., Carmassi, C., Siracusano, A., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.114073 · Cited by 27 · see citing works
He, X., Ma, Q., Fan, Y., Zhao, B., Wang, W., Zhu, F., Ma, X., & Zhou, L. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s218483 · Cited by 26 · see citing works
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Giordano, G. M., Pezzella, P., Quarantelli, M., Bucci, P., Prinster, A., Soricelli, A., Perrottelli, A., Giuliani, L., Fabrazzo, M., & Galderisi, S. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm11010061 · Cited by 20 · see citing works
Giordano, G. M., Perrottelli, A., Mucci, A., Lorenzo, G. D., Altamura, M., Bellomo, A., Brugnoli, R., Corrivetti, G., Girardi, P., Monteleone, P., et al. (2021) · Brain Sciences · doi:10.3390/brainsci11121632 · Cited by 17 · see citing works
Cuesta, M. J., Sánchez-Torres, A. M., Lorente-Omeñaca, R., Moreno-Izco, L., Peralta, V., SegPEPs Group, Ballesteros, A., de Jalón, E. G., Gil‐Berrozpe, G. J., Hernández-Antón, R., et al. (2020) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-020-01188-x · Cited by 16 · see citing works
Giordano, G. M., Palumbo, D., Mucci, A., Ventura, J., Giuliani, L., Perrottelli, A., Bucci, P., Rocca, P., Rossi, A., Bertolino, A., et al. (2022) · Schizophrenia Research · doi:10.1016/j.schres.2022.01.029 · Cited by 16 · see citing works
Giordano, G. M., Giuliani, L., Perrottelli, A., Bucci, P., Lorenzo, G. D., Siracusano, A., Brando, F., Pezzella, P., Fabrazzo, M., Altamura, M., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10245838 · Cited by 15 · see citing works
Giordano, G. M., Brando, F., Perrottelli, A., Lorenzo, G. D., Siracusano, A., Giuliani, L., Pezzella, P., Altamura, M., Bellomo, A., Cascino, G., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.790745 · Cited by 15 · see citing works
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Lenze, E. J., Torous, J. B., & Areán, P. A. (2023) · Neuropsychopharmacology · doi:10.1038/s41386-023-01664-7 · Cited by 10 · see citing works
Nucifora, L. G., Ishizuka, K., Demerdash, N. E., Lee, B. J., Imai, M. T., Ayala‐Grosso, C. A., Yenokyan, G., Cascella, N. G., Lin, S. Y., Schretlen, D. J., et al. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-02956-8 · Cited by 10 · see citing works
Self-citationTanioka, R., Osaka, K., Ito, H., Zhao, Y., Tomotake, M., Takase, K., & Tanioka, T. (2023) · Healthcare · doi:10.3390/healthcare11050684 · Cited by 9 · see citing works
Joaquim, H. P. G., Costa, A. C., Talib, L. L., Dethloff, F., Serpa, M. H., Zanetti, M. V., van de Bilt, M. T., & Turck, C. W. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00496 · Cited by 9 · see citing works
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Giordano, G. M., Galderisi, S., Pezzella, P., Perrottelli, A., & Bucci, P. (2022) · Comprehensive approach to psychiatry · doi:10.1007/978-3-030-98301-7_2 · Cited by 8 · see citing works
Wang, D., Du, Y. X., Zhu, R., Tian, Y., Chen, J. J., Chen, D. C., Wang, L., & Zhang, X. (2021) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2021.2013093 · Cited by 7 · see citing works
Palumbo, D., Caporusso, E., Piegari, G., Mencacci, C., Torriero, S., Giuliani, L., Fabrazzo, M., Pinto, D., & Galderisi, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.833550 · Cited by 6 · see citing works
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Pezzella, P., Caporusso, E., Mucci, A., Bucci, P., Giordano, G. M., Amore, M., Rocca, P., Rossi, A., Bertolino, A., Ventura, J., et al. (2024) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgae020 · Cited by 5 · see citing works
Davies, J. L., Watt, A. A., Bagshaw, R., Hill, C., & Seage, C. H. (2023) · International Journal of Forensic Mental Health · doi:10.1080/14999013.2023.2218287 · Cited by 3 · see citing works
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Paulino, R. S., Tangco-Siason, A., & Siason, N. D. (2026) · Frontiers in Education · doi:10.3389/feduc.2026.1750768 · Cited by 1 · see citing works
Sustrami, D., Suhardiningsih, A. S., Setyowati, A., Fauk, N. K., & Arifin, H. (2024) · Jurnal Keperawatan Padjadjaran · doi:10.24198/jkp.v12i3.2599 · Cited by 1 · see citing works
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Poole, L. G., Ude, A. A., Perdue, H. M., Bourque, J. R., Sarwani, A., Dhruve, A. P., & Alderman, B. L. (2024) · Frontiers in Cognition · doi:10.3389/fcogn.2024.1387239
Anbasse, G., Tessema, W., Negash, A., & Alenko, A. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s452866
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Yu, W., Tao, B., Zhao, Q., Xiao, Y., Gao, Z., Zhu, F., Zhao, Y., & Lui, S. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.5070303
Huang, R.-C., Wareesawetsuwan, N., Lin, N., & Li, X.-D. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i11.112431
Cuevas, C. D. L. (2026) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20251120
Pereira, S. I. D. S., de Oliveira, I. B., Ferreira, M. H. L., Mert, A., Prado, M. L. D. L., LYRA, G. O. T., de Araújo, J. C., Xavier, D., de Aguiar, D. R., & Sherpa, N. N. (2026) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2026.104979
Klein, H., Horan, W. P., Clarke, N. A., Howells, F. M., Cocks, K., Daskalopoulou, C., Pascoe, B., Reaney, M. D., Langevin, N., Fowler, C., et al. (2026) · Schizophrenia Bulletin · doi:10.1093/schbul/sbag167
Self-citation
- Authors
- Harvey, P. D., & Strassnig, M. T.
- Affiliations
- University of Miami (US)
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2019-05-06
- Volume
- 18
- Issue
- 2
- Pages
- 165-167
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6502430
- OpenAlex
- W2944011422
- Cited by
- 37
- References
- 9
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 11 · 2020: 6
- FWCI
- 3.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- schizophrenia, cognitive impairment, social cognition, functional capacity, social competence, disability, global burden of disease, physical fitness, exercise intervention, obesity, comorbidities, decision-making, quality of life, daily functioning, cognitive remediation, pharmacotherapy, motivation, reward sensitivity, neurobiological correlates
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