Psychological Medicine

Original Articles

Pathways between early visual processing and functional outcome in schizophrenia

Y. Rassovskya1 c1, W. P. Horana1a2, J. Leea1, M. J. Sergia3 and M. F. Greena1a2

a1 Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA

a2 VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

a3 California State University, Northridge, CA, USA


Background Early visual processing deficits are reliably detected in schizophrenia and show relationships to poor real-world functioning. However, the nature of this relationship is complex. Theoretical models and recent studies using statistical modeling approaches suggest that multiple intervening factors are involved. We previously reported that a direct and significant association between visual processing and functional status was mediated by a measure of social perception. The present study examined the contribution of negative symptoms to this model.

Method We employed structural equation modeling (sem) to test several models of outcome, using data from 174 schizophrenia out-patients. Specifically, we examined the direct and indirect relative contributions of early visual processing, social perception and negative symptoms to functional outcome.

Results First, we found that, similar to social perception, a measure of negative symptoms mediated the association between visual information processing and functional status. Second, we found that the inclusion of negative symptoms substantially enhanced the explanatory power of the model. Notably, it was the experiential aspect of negative symptoms (avolition and anhedonia) more than the expressive aspect (affective flattening and alogia) that accounted for significant variance in functional outcome, especially in the social component of the construct of functional outcome.

Conclusions Social perception and negative symptoms play relevant roles in functional impairment in schizophrenia. Both social perception and negative symptoms statistically mediate the connection between visual processing and functional outcome. However, given the lack of association between social perception and negative symptoms, these constructs appear to have an impact on functioning through separate pathways.

(Received September 17 2009)

(Revised April 08 2010)

(Accepted April 10 2010)

(Online publication May 19 2010)


c1 Address for correspondence: Y. Rassovsky, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza (C8-746), Los Angeles, CA 90095, USA. (Email: