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Queen's University

Recent Papers 

In this tab we provide a synopsis of our own recently published work.



Bowie CR, McGurk SM, Mausbach BT, Patterson TL, Harvey PD. Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real world behavior. American Journal of Psychiatry, 2012, 169, 710-718

This paper represents a true labour of love. It was funded as a two-year Young Investigator Award to Bowie in 2006, was started in NYC and transferred to Queen's. It represents a large scale study of the independent and synergistic effects of cognitive remediation and skills training, demonstrating larger, more functionally relevant, and more durable effects when these treatments are combined.




Harvey PD & Bowie CR. Cognitive remediation in severe mental illness. Innovations in Clinical Neurscience, 2012, 9,27-30.

This review paper presents a succinct state of the field and directions for future work.



Gupta M, Holshausen K, Mausbach B, Patterson T, Bowie CR. Predictors of change in functional competence and real world behavior following Functional Adaptation Skills Training for schizophrenia. Journal of Mental and Nervous Disease, 2012, 200, 705-711

Grad Student Maya took the lead on an analysis of variables that predict changes in schizophrenia patients' competence to perform everyday skills and their actual use of those skills after they completed a skills intervention developed by our colleagues in San Diego, Tom Patterson and Brent Mausbach. Performance at baseline on neurocognitive tests.  Clinical symptoms did not predicted improvement but it appears that a poorer course of illness with more time in hospital limits the chance of benefiting from these types of treatment.





Bowie CR, McLaughlin D, Carrión RE, Auther AM, & Cornblatt BA. Cognitive changes following antidepressant or antipsychotic treatment in adolescents at clinical risk for psychosis. Schizophrenia Research, February 2012.


This study presents the primary findings from a NARSAD award to Bowie while he was a post-doctoral fellow with Barbara Cornblatt and her group that studies individuals at high clinical risk for psychosis. In the paper, we examined the neurocognitive performance of individuals at clinical high risk (CHR) for developing psychosis, prior to and following the initiation of pharmacological treatment. While impairments in neurocognitive domains have been widely recognized as stable and functionally-relevant features of schizophrenia, the magnitude of impairment exhibited by CHR individuals is significantly lower than patients with chronic schizophrenia. Given the presence of relatively milder deficits in CHR individuals, it remains unknown whether early pharmacological efforts can have a meaningful influence on clinical and neurocognitive outcomes. In the present study, participants who were at CHR for psychosis were prescribed antipsychotic or antidepressant medication and were administered a standardized neuropsychological battery, along with a clinical symptom assessment, at study entry and approximately 6 months post-pharamacological treatment. The same measures were administered to a group of drug-naïve CHR patients who were matched on neurocognitive functioning and symptom severity, and a group of healthy controls. No group differences were reported in terms of clinical symptom severity at follow-up. However, individuals treated with antidepressants had notable improvements in verbal learning and sustained attention compared to those treated with antipsychotics, but not compared to those who remained off medications or controls.




Cardenas V, Abel S, Bowie CR, Tiznado D, Depp CA, Patterson TL, Jeste DV, & Mausbach BT. When functional capacity and real-world functioning converge: The role of self-efficacy. Schizophrenia Bulletin, February 2012.


Cardenas and colleagues investigated the role of motivational factors moderating the relationship between functional capacity and real-world performance. While impairments in functional capacity are a core feature of schizophrenia, there is much heterogeneity in functional outcomes among those afflicted by the disorder. Considering the role of self-efficacy, it stands to reason that some individuals may have the capacity to engage in functional behaviours but lack the confidence to actually perform these behaviours in a real-world setting. In a sample of 97 middle-aged and older adults the authors examined the moderating role of self-efficacy in the relationship between functional capacity and real-world behaviour. When self-efficacy was high, functional capacity and real-world functional outcome were significantly related, whereas the reverse was true when self-efficacy was low. The same relationship was observed in self-reported social and work functioning. These findings have important implications for understanding the competence-performance discrepancy often evident in schizophrenia, as they suggest that while functional capacity is an important predictor of real-world functioning it may not be sufficient in the absence of motivation.  




Gould F, Bowie CR, Harvey PD. The influence of demographic factors on functional capacity and everyday functional outcomes in schizophrenia. Journal of Clinical and Experimental Neuropsychology, January 2012.

In this paper, we examined the relationship between demographic factors, functional capacity and everyday functional outcomes in individuals with schizophrenia. Individuals with schizophrenia have impaired everyday living outcomes. Previous research has demonstrated that neuropsychological performance and functional capacity measures are useful in predicting the degree of impairment in everyday living. The current study examined the predictive value of demographic factors (age, race, gender, and education), neuropsychological performance, and functional capacity in predicting functional outcomes in 194 outpatients with schizophrenia. Age, education, sex, and racial status were significantly, but modestly, associated with performance-based measures of everyday functioning, while, in addition, age and education had a similar modest relationship with social competence. Age was the only demographic variable that contributed to the prediction of all three domains of everyday functioning. Functional capacity measures significantly predicted functional outcomes even when demographic factors were entered into the predictive model first. Older age appears to be related to poorer functioning in individuals with schizophrenia, even after functional capacity is taken into consideration. This is similar to findings in healthy populations without clinically notable cognitive impairments. 






Mausbach, BT, Roepke, SK, Chattillion, EA, Harmell, AL, Moore, R, Romero-Moreno, R, Bowie, CR, Grant, I. Multiple Mediators of the Relations Between Caregiving Stress and Depressive Symptoms. Aging & Mental Health, January 2012.


In this paper from collaborators in San Diego, Brent Mausbach and colleagues investigated the relationship between stress and depressive symptoms in elderly spouse caregivers of patients with Alzheimer’s disease (AD). Previous research has shown that cognitive and behavioural problems in Alzheimer’s patients can adversely impact the psychiatric well-being of their caregivers, but certain coping responses may mediate this relationship. The authors hypothesized that caregiving stress would be significantly associated with four intermediate factors; namely, personal mastery (i.e., one’s perceived control over life circumstances), self-efficacy in performing actions to cope with stress, restrictions in daily social and recreational activities, and the use of avoidance to deal with stress. All of the four proposed mediators were found to be important in explaining the stress-to-depression pathway in spousal AD caregivers. More specifically, caregiving stress was significantly associated with decreased personal mastery and self-efficacy, and increased activity restriction and avoidance coping.  Results from this study provide insight into the factors that play a crucial role in the development and maintenance of depressive symptoms for AD caregivers, and also highlight useful targets for psychosocial interventions.





Loewenstein DA, Czaja SJ, Bowie CR, Harvey PD. Age-Associated Differences in Cognitive Performance in Older Patients with Schizophrenia: A Comparison with Healthy Older Adults. Am J Geriatr Psychiatry, January 2012.

In this paper the association between age and cognitive performance among individuals with schizophrenia was examined. Normal aging processes result in cognitive decline in healthy adults, however the effect aging has on the cognitive abilities of individuals with schizophrenia is controversial. This study compared individuals with schizophrenia to healthy adults in order to determine the effect of aging on both groups. Healthy adults age 70 and older performed superior to individuals with schizophrenia who were only 40-49 years old on measures of working and episodic memory, executive function, and psychomotor speed. In addition to these findings, age seemed to play a greater role for individuals with schizophrenia than for healthy adults on measures of verbal learning and speed of processing. These findings highlight the fact that schizophrenia is associated with cognitive impairment across all ages as well as illustrating that older individuals with schizophrenia experience greater age associated declines in cognitive functioning than healthy adults. These findings have broad implications for treatment strategies for older individuals with schizophrenia as well as the ability of these individuals to function independently. 




Gupta M, Bassett E, Iftene F, Bowie CR. Functional outcomes in schizophrenia: understanding the competence-performance discrepancy. J Psychiatr Res, in press. 

In this paper, Maya, former lab RA Emma, our colleague Felicia Iftene from the Dept of Psychiatry, and Bowie examined baseline data from the NARSAD funded study on cognitive remediation. Previous work has found robust correlations among measures that index one's ability and one's actual behaviours in the real world, but there are a large proportion of cases where real world performance is substantially less than expected given one's abilities. This paper is the first to examine the predictors of this discrepancy and points to a number of subject characteristics (neurocognition), course of illness (time spent in hospitals) and environmental factors (living in a more restricted residence) that help explain why people with schizophrenia might underperform in the real world even when they are functionally skilled. There are important implications related to the need to consider environmental factors when evaluating whether treatment techniques that focus on the individual's symptoms result in transfer to everyday behaviour changes. (Nice job Maya!)











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