Single versus dual pathways to functional outcomes in schizophrenia: Role of negative symptoms and cognitive function

Background: The functional outcomes for many patients with schizophrenia remain poor, and the specific determinants for and pathways to functional outcomes are not well understood to date. It is unknown whether major determinants of outcomes are achieved via a motivated single pathway or by the motivation and capacity defined in dual pathways. This study investigated whether different aspects of functional outcomes, such as residential, social, and vocational outcomes, are the main determinants of the experience factors for negative symptoms or whether the experience factors and cognitive function are the determinants. Method: We enrolled 107 patients with schizophrenia. The Social Functioning Scale domains were used to examine whether a single or dual pathway is appropriate for each domain based on the model fit using structural equation modeling. Results: The model goodness of fit criterion showed a dual pathway for residential and vocational outcomes. In contrast, social and recreational outcomes showed a single pathway. Conclusion: The major determinants were clearly different for each outcome. Therefore, we emphasize the importance of using different treatment strategies for each outcome. Irrespective of the factors approached, social and recreational outcomes should ultimately focus on motivation. The findings also suggest that interventions should be combined for vulnerable cognitive functions and motivational interventions for residential and vocational outcomes.