Cognitive and clinical predictors of functional capacity in patients with first episode schizophrenia Lone Vesterager a, b, ⁎, Torben Ø. Christensen c , Birthe B. Olsen c , Gertrud Krarup c , Marianne Melau a , Hysse B. Forchhammer d , Merete Nordentoft a, b a Psychiatric Centre Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark b University of Copenhagen, Faculty of Health Sciences, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark c Psychiatric Hospital Risskov, Aarhus University Hospital, Tretommervej 3, DK-8240, Aarhus, Denmark d Department of Neurology, Copenhagen University Hospital Glostrup, Nordre Ringvej 57, DK-2600, Glostrup, Denmark abstract article info Article history: Received 20 June 2012 Received in revised form 14 August 2012 Accepted 27 August 2012 Available online 25 September 2012 Keywords: Working memory Social cognition Negative symptoms Functional capacity First episode schizophrenia Real-world functioning Background: The predictors of functional capacity in first episode schizophrenia among seven separable cognitive domains and clinical variables are unknown. Aim: To investigate predictors of functional capacity in first episode schizophrenia and the associations between functional capacity and measures of real-world functioning. Methods: Socio-demographic, clinical, and cognitive measures from a sample of patients with first episode schizophrenia spectrum disorders aged 18–34 years (N=117) were examined at baseline, 4-month follow‐ up, and 10-month follow-up and used to predict concurrent and longitudinal functional capacity. Symptoms were assessed with the Positive and Negative Syndrome Scale, cognitive functioning with the MATRICS Cognitive Consensus Battery, and functional capacity with the brief version of the University of California San Diego Performance-based Skills Assessment. Linear and logistic regression analyses were adjusted for age, gender, and site. Results: Working memory, negative symptoms, and social cognition accounted for 41% of the variance in func- tional capacity at baseline. Longitudinally, verbal learning, working memory, and negative symptoms predicted 4-month functional capacity. Working memory and visual learning predicted 10-month functional capacity. Functional capacity was associated to global functioning in the univariate analysis, but in multivariable analyses global functioning, financial independence, and independent living were predicted by negative symptoms or general symptoms explaining 15–23% of the variance. Conclusions: The strongest single predictor of functional capacity is working memory, followed by negative symptoms. Clinical symptoms, but not functional capacity, predicted real-world functioning. The usability of the UPSA-B in first episode schizophrenia is discussed. Neurocom, ClinicalTrials.gov Identifier: NCT00472862, http://clinicaltrials.gov/ct2/show/NCT00472862?term=neurocom&rank=1. © 2012 Elsevier B.V. All rights reserved. 1. Background Cognitive dysfunction is a core feature of schizophrenia and a strong predictor of functional outcome. Development of cognitive remediation and enhancement therapies has stressed the importance of measuring functional improvement and awareness on the distinction between the patient's actual performance in real life and capacity. Performance- based assessment of functional capacity with its non-reliance on patient's insight is regarded a feasible and ecologically valid way to evaluate everyday functioning (Moore et al., 2001; McKibbin et al., 2004; Leifker et al., 2009; Patterson and Mausbach, 2010). Identification of cognitive and clinical domains involved in func- tional capacity would propose important targets for cognitive reme- diation and other interventions aiming to improve functioning. The associations between functional capacity and socio-demographic, clinical, and cognitive variables have been explored in patients with schizophrenia in their mid-thirties to sixties (Twamley et al., 2002; Bowie et al., 2006; Keefe et al., 2006a; McClure et al., 2007; Cardenas et al., 2008; Mausbach et al., 2010), but not in a sample of young adults with first episode schizophrenia. The University of California San Diego Performance-based Skills Assessment (UPSA) is the most commonly used functional capacity measure and is evaluated to have the strongest properties among performance-based and interview-based measures of functioning (Green et al., 2011). It has been attributed with substantial construct Schizophrenia Research 141 (2012) 251–256 ⁎ Corresponding author at: Psychiatric Centre Copenhagen, Research Department, Copenhagen University Hospital, Building 13A, 3rd Floor, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark. Tel.: +45 50 53 11 10; fax: +45 38 64 75 04. E-mail addresses: lone.vesterager@regionh.dk (L. Vesterager), torben.christensen@rn.dk (T.Ø. Christensen), birtolse@rm.dk (B.B. Olsen), gertrud.krarup@regionh.dk (G. Krarup), marianne.melau@regionh.dk (M. Melau), hypf@glo.regionh.dk (H.B. Forchhammer), mn@dadlnet.dk (M. Nordentoft). 0920-9964/$ – see front matter © 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.schres.2012.08.023 Contents lists available at SciVerse ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres