Assessment of everyday functioning in schizophrenia.

Patients with schizophrenia manifest substantial cognitive and functional impairments. Assessment of these impairments is complicated by impairments in the accuracy of self-assessment of functioning on the part of both people with schizophrenia and certain classes of informants. Many of these reports correlate close to zero with performance measured objectively by performance-based tests. Much like the phenomenon of lack of insight, unawareness of functional impairments is predicted by cognitive impairments. In addition, like other neuropsychiatric conditions and healthy individuals, mild depression is associated with increased accuracy of self-assessment. High-contact clinicians may provide reports of functioning that are more convergent with patients' ability as measured by performance-based assessments. Clinicians who are assessing deficits in cognition and everyday functioning may need to carefully consider the source of the information obtained before making treatment and placement decisions.