Critical issues in the assessment of disability in schizophrenia

Individuals with schizophrenia exhibit functional disability across a wide array of domains. These patients experience impairments in their social competence, vocational aptitude, everyday living skills, and self-care abilities, which in the majority of patients are severe enough to prevent the return to independent living, even after hallmark symptoms such as hallucinations and delusions are remitted. Unfortunately, assessment of the magnitude of disability in individual patients is hindered by several factors, such as reduced capability in the area of self-evaluation and inaccuracies in self-report, as well as the presence of potential contributing variables such as depression and poor self-esteem. Furthermore, additional barriers to recovery exist, such as fear of losing disability payments and factors such as discrimination. Performance-based measures of functioning are new and promising instruments for assessing the competencies of patients and address many of the problems with other methods of assessing disability. These measures could greatly aid clinicians in understanding the schizophrenia disease and recovery process, expanding treatment goals beyond the currently targeted positive and negative symptoms.