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Protocol - Social and Role Dysfunction in Psychosis and Schizophrenia

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Description

Global Functioning: Social and Global Functioning: Role scales are 7 social-scale prompts and 4-item clinician-administered interviews that include detailed anchors for prodromal problems relevant for the typical age range for the prodromal phase. Each question is scored on a 10-point scale (10 = superior function; 1 = extreme dysfunction) and captures current functioning, lowest functioning over the past year, and highest functioning over the past year. Example prompts/questions are included.

Specific Instructions

None

Availability

Available

Protocol

Global Functioning: Social Scale (GF: Social)

Current _________

Lowest Past Year___________

Highest Past Year___________

Check here if this is a retrospective rating.

Superior social/interpersonal functioning

10

Superior functioning in a wide range of social and interpersonal activities. Frequently seeks out others and has multiple satisfying interpersonal relationships, including multiple close and casual friends. Is sought out by others because of his or her many positive qualities. Age-appropriate involvement in intimate relationships.

Above average social/interpersonal functioning

9

Good functioning in all social areas, and interpersonally effective.

Interested and involved in a wide range of social and interpersonal activities, including both close and casual friends. Age-appropriate involvement in intimate relationships. No more than everyday interpersonal problems or concerns (e.g., an occasional argument with spouse, girlfriend/boyfriend, friends, coworkers, or classmates). Able to resolve such conflicts appropriately.

Good social/interpersonal functioning

8

Some transient mild impairment in social functioning.

Mild social impairment is present, but transient and expectable reactions to psychosocial stressors (e.g., after minor arguments with spouse, girlfriend/boyfriend, friends, coworkers, or classmates). Has some meaningful interpersonal relationships with peers (casual and close friends), and/or age-appropriate intimate relationships. Infrequent interpersonal conflict with peers.

Mild problems in social/interpersonal functioning

7

Some persistent mild difficulty in social functioning.

Mild impairment present that is NOT just expectable reaction to psychosocial stressors (e.g., mild conflicts with peers, coworkers or classmates; difficulty resolving conflicts appropriately). Has some meaningful interpersonal relationships with peers (casual and/or close friends). Some difficulty developing or maintaining age-appropriate intimate relationships (e.g., multiple short-term relationships).

Moderate impairment in social/interpersonal functioning

6

Moderate impairment in social functioning.

Moderate impairment present (e.g., few close friends; significant but intermittent conflicts with peers, coworkers, or classmates). Moderate difficulty developing age-appropriate intimate relationships (e.g., infrequent dating). Occasionally seeks out others but will respond if invited by others to participate in an activity.

Serious impairment in social/interpersonal functioning

5

Serious impairment in social functioning.

No close friends or intimate partner but has some casual social contacts (e.g., acquaintances, school/work friends only). Rarely seeks out others. Occasional combative or verbally argumentative behavior with peers. Beginning to withdraw from family members (e.g., does not initiate conversation with family, but will respond if addressed).

Major impairment in social and interpersonal functioning

4

Major impairment in social functioning.

Serious impairment in relationships with friends or peers (e.g., very few or no friends, frequent conflicts with friends, or frequently avoids friends). Frequent combative or verbally argumentative behavior with peers. Infrequent contact with family members (e.g., sometimes does not respond to family or avoids family members).

Marginal ability to function socially

3

Marginal ability to function socially or maintain interpersonal relationships.

Frequently alone and socially isolated. Serious impairment in relationships with all peers, including acquaintances. Few interactions with family members (e.g., often alone in room). Serious impairment in communication with others (e.g., avoids participating in most social activities).

Inability to function socially

2

Unable to function socially or to maintain any interpersonal relationships.

Typically alone and socially isolated. Rarely leaves home. Rarely answers the phone or the door. Rarely participates in interactions with others at home or in other settings (e.g., work, school).

Extreme social isolation

1

Extreme social isolation.

No social or family member contact at all. Does not leave home. Refuses to answer the phone or door.

Please rate the patient’s most impaired level of social functioning for the specified time period by selecting the ‘‘lowest’’ level which describes his/her functioning within that time frame. For ‘‘current,’’ rate most impaired level of functioning in the ‘‘past month.’’ Rate actual functioning regardless of etiology of social problems.

Note: The emphasis is on social contact/interactions with people other than family members, unless these are the only interpersonal contacts a person has (e.g., the lower end of the scale). Also note that ratings of intimate relationships are secondary to the rating of primary friendships and should take into account the age of the individual. For example, older individuals may be expected to have intimate relationships involving steady dating, cohabitation, or marriage, whereas younger individuals may be expected to have only romantic interests (i.e., flirtations or crushes) or close friendships.

Global Functioning: Social Scale Prompts

Specific questions to aid in rating the GF: Social scale are provided below. Be sure to assess for changes in social functioning over the previous year (to rate highest and lowest) as well as current functioning in the past month.

1. Tell me about your social life. Do you have friends?

2. Are they casual or close friends? If only casual-are they school or work friends only? If close-how long have you been close friends?

3. How often do you see friends? Do you see them outside of work/school? When was the ‘‘last time’’ you saw one of your friends outside of work/school? (Attempt to determine ‘‘actual’’ amount of social contact vs. perceived amount of social contact.)

4. Do you usually initiate contact or activities with friends or do they typically call or invite you? Do you ever avoid contact with friends?

5. Do you ever have problems/falling outs with friends? Arguments or fights?

6. Are you dating or interested in dating? (Alter as needed to assess age-appropriate intimate relationships.)

7. Do you spend time with family members (at home)? How often do you communicate with them? Do you ever avoid contact with family members?

Global Functioning: Role Scale (GF: Role)

Current _________

Lowest Past Year___________

Highest Past Year___________

Check here if this is a retrospective rating.

Superior role functioning

10

Independently maintains superior functioning in demanding roles. Obtains only superior performance evaluations at competitive work placement. Obtains all A’s in mainstream school. Generates, organizes, and completes all homemaking tasks with ease.

Above-average role functioning

9

Independently maintains very good functioning in demanding roles. Rarely absent or unable to perform. Obtains good-to-superior performance evaluations at competitive work placement. Obtains grades in A and B range in all courses in mainstream school. Generates, organizes, and completes all homemaking tasks.

Good role functioning

8

Independently maintains good role functioning in demanding roles. Occasionally falls behind on tasks but always catches up; obtains satisfactory performance evaluations at competitive work placement; obtains grades of C and above in mainstream school; occasional difficulty generating or organizing homemaking tasks; or maintains above-average performance with minimal support (e.g., tutoring, reduced academic course load at 4-year university, attends community college, may receive additional guidance at work less than 1-2 times a week). Receives A’s and B’s, good work/school evaluations, and completes all tasks with this level of support.

Mild impairment in role functioning

7

Mildly impaired functioning in demanding roles independently. Frequently behind on tasks or unable to perform; frequently obtains poor performance evaluations at competitive work placement or grades of D’s or better in mainstream school; frequent difficulty generating or organizing homemaking tasks; or maintains good performance with minimal support (e.g., minimal accommodations in general education classroom, receives additional guidance/support at work 1-2 times a week). Receives C’s or higher, satisfactory work/school evaluations, and completes most homemaking tasks with this level of support.

Moderate impairment in role functioning

6

Moderate impairment independently. May receive occasional F in mainstream courses, persistently poor performance evaluations at competitive work placement; may change jobs because of poor performance, persistent difficulty generating, or organizing homemaking tasks; or requires partial support (some resource or special education courses, receives guidance/support at work 2 times per week). May require less demanding or part-time jobs and/or some supervision in home environment but functions well or adequately given these supports (may fall behind but eventually completes assigned tasks, obtains satisfactory evaluations at work or passing grades in school).

Serious Impairment in Role Functioning

5

Serious impairment independently. Failing multiple courses in mainstream school, may lose job, or unable to complete most homemaking tasks independently; or in entirely special education classes, requires less demanding job/daily support or guidance, may require vocational rehabilitation, and/or some supervision in home environment but maintains ‘‘above average’’ performance-receives A’s and B’s, good evaluations at work/school, completes all tasks.

Major impairment in social and interpersonal functioning

4

Very serious impairment independently. All F’s in mainstream school or failing out of school; cannot obtain or hold independent job or unable to complete virtually any homemaking tasks independently; or adequate to good functioning with major support. Requires assisted work environment, entirely special education classes, nonpublic or psychiatric school, home schooling for the purpose of a supportive school environment, and/or supported home environment but functions adequately given these supports (may fall behind but completes assigned tasks, obtains satisfactory performance evaluations at work or passing grades).

Marginal ability to function

3

Impaired functioning with major support. Requires supported work environment, entirely special education classes, nonpublic or psychiatric school, home schooling for the purpose of a supportive school environment, and/or supported home environment but functions poorly despite these supports (persistently behind on tasks, frequently unable to perform, obtains poor performance evaluations at work or fails courses at school).

Inability to function

2

Disabled but participates in structured activities. On disability or equivalent nonindependent status. Not working for pay, attending classes for grades, or living independently. Spends 5 or more hours a week in structured role-related activities (e.g., residential treatment, volunteering, tutoring, sheltered work programs).

Extreme role dysfunction

1

Severely disabled. On disability or equivalent nonindependent status. Not working for pay, attending classes for grades, or living independently. Spends fewer than 5 hours a week in structured role-related activities.

Please rate the patient’s ‘‘lowest’’ level of functioning in occupational, educational, and/or homemaker roles, as appropriate, within specified time frame. For ‘‘current,’’ rate most impaired level of functioning for the ‘‘past month.’’ Rate actual functioning regardless of etiology of occupational/educational problems.

Note: This scale emphasizes the level of support provided within the individual’s environment and the individual’s performance given such support. The term ‘‘independently’’ as used throughout this instrument implies that an individual is functioning at an ‘‘age appropriate level’’ without the assistance of external supports or accommodations. Examples of independent functioning include (1) age-appropriate functioning in a mainstream school without requiring extra help, special

classes, or special accommodations for testing; (2) competitive full-time employment without additional guidance, support, job coaching, or other forms of special assistance; and (3) full-time homemaker responsible for generating, organizing, and pacing of household tasks and activities for a family without additional guidance, support, or supervision.

Global Functioning: Role Scale Prompts

Be sure to assess for changes in role functioning over the previous year (to rate highest and lowest) as well as current functioning within the past month. Determine and rate functioning for ‘‘primary role’’ setting (work, school, or home) based upon questions below. However, if the subject is engaged in multiple roles, consider total amount of time spent in role-related activities (i.e., part-time school plus part-time work equals full-time role status).

  1. How do you spend your time during the day?
  2. If currently working:
    1. Where do you work? What are your job responsibilities?
    2. How many hours a week do you work?
    3. How long have you been in your current job? Have you had any recent changes in your job status (e.g., lost job, stopped working, changed position, or workload)?
    4. Do you usually need assistance or regular supervision at work? How often do you need extra help? Are there any tasks that you are not able to do alone?
    5. Do you ever have trouble keeping up? Are you able to catch up if you fall behind?
    6. Have you received any comments (positive or negative) or formal reviews regarding your performance? Have others pointed out things that you have done well or poorly?

  3. If currently attending school:
    1. What type of school do you attend? (general education, nonpublic school, residential/hospital)
    2. Have you ever been in special education classes or other non-general education classes?
    3. How long have you been at this school? Have you had any recent changes in your school placement?
    4. Do you receive any extra help or accommodations in your classes? Do you receive tutoring or extra help in school or after school? Do you receive extra time to take tests or are you able to leave the classroom to take tests in a quiet place?
    5. Do you have trouble keeping up with your coursework? Are you able to catch up if you fall behind?
    6. How are your grades? Are you failing any classes?

  4. If a homemaker:
    1. What are your responsibilities around the house or for the family?
    2. How long have you been in charge of the home?
    3. How many hours per week do you spend working on household tasks?
    4. Are you able to keep up with the demands of your household? Do you ever fall behind? If so, are you able to catch up or do you need others’ help? Are you avoiding any tasks? Do you need regular assistance or supervision for any tasks within the home?
    5. Have you received any comments (positive or negative) regarding your performance? Have others pointed out things that you have done well or poorly?
Personnel and Training Required

The interviewer should be trained in the administration of the Global Functioning: Social and Global Functioning: Role scales. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Lifestage

Adolescent, Adult

Participants

Adolescents and adults, ages 12 and older

Selection Rationale

The Global Functioning: Social and Global Functioning: Role scales are brief, validated, reliable, and widely used clinician-administered interviews that include detailed anchors for capturing prodromal problems.

Language

English

Standards
StandardNameIDSource
Human Phenotype Ontology Psychosis HP:0000709 HPO
Human Phenotype Ontology Behavioral abnormality HP:0000708 HPO
Human Phenotype Ontology Schizophrenia HP:0100753 HPO
Human Phenotype Ontology Abnormal social behavior HP:0012433 HPO
Human Phenotype Ontology Impaired social interactions HP:0000735 HPO
caDSR Form PhenX PX661201 - Social And Role Dysfunction In Psychosis And Schizophren 6887254 caDSR Form
Derived Variables

None

Process and Review

Not applicable.

Protocol Name from Source

Cornblatt, B.A., et al. Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophr. Bull., 2007

Source

Cornblatt, B. A., Auther, A. M., Niendam, T., Smith, C. W., Zinberg, J., Bearden, C. E., & Cannon, T. D. (2007). Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin, 33(3), 688-702.

General References

Alderman, T., Addington, J., Bearden, C., Cannon, T. D., Cornblatt, B. A., McGlashan, T. H., Perkins, D. O., Seidman, L. J., Tsuang, M. T., Walker, E. F., Woods, S. W., & Cadenhead, K. S. (2015). Negative symptoms and impaired social functioning predict later psychosis in Latino youth at clinical high risk in the North American prodromal longitudinal studies consortium. Early Intervention in Psychiatry, 9(6), 467-475.

Niendam, T. A., Bearden, C. E., Johnson, J. K., McKinley, M., Loewy, R., O’Brien, M., Nuechterlein, K. H., Green, M. F., & Cannon, T. D. (2006). Neurocognitive performance and functional disability in the psychosis prodrome. Schizophrenia Research, 84(1), 100-111.

Protocol ID

661201

Variables
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX661201_SocialGlobal_Functioning_Dating_Current
PX661201050000 [CURRENT RATING] Are you dating or more
interested in dating? (Alter as needed to assess age-appropriate intimate relationships.) show less
N/A
PX661201_SocialGlobal_Functioning_Dating_Highest
PX661201190000 [HIGHEST IN PAST YEAR] Are you dating or more
interested in dating? (Alter as needed to assess age-appropriate intimate relationships.) show less
N/A
PX661201_SocialGlobal_Functioning_Dating_Lowest
PX661201120000 [LOWEST IN PAST YEAR] Are you dating or more
interested in dating? (Alter as needed to assess age-appropriate intimate relationships.) show less
N/A
PX661201_SocialGlobal_Functioning_Family_Current
PX661201060000 [CURRENT RATING] Do you spend time with more
family members (at home)? How often do you communicate with them? Do you ever avoid contact with family members? show less
N/A
PX661201_SocialGlobal_Functioning_Family_Highest
PX661201200000 [HIGHEST IN PAST YEAR] Do you spend time more
with family members (at home)? How often do you communicate with them? Do you ever avoid contact with family members? show less
N/A
PX661201_SocialGlobal_Functioning_Family_Lowest
PX661201130000 [LOWEST IN PAST YEAR] Do you spend time with more
family members (at home)? How often do you communicate with them? Do you ever avoid contact with family members? show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Current
PX661201010000 [CURRENT RATING] Are they casual or close more
friends? If only casual-are they school or work friends only? If close-how long have you been close friends? show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Fights_Current
PX661201040000 [CURRENT RATING] Do you ever have more
problems/falling outs with friends? Arguments or fights? show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Fights_Highest
PX661201180000 [HIGHEST IN PAST YEAR] Do you ever have more
problems/falling outs with friends? Arguments or fights? show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Fights_Lowest
PX661201110000 [LOWEST IN PAST YEAR] Do you ever have more
problems/falling outs with friends? Arguments or fights? show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Highest
PX661201150000 [HIGHEST IN PAST YEAR] Are they casual or more
close friends? If only casual-are they school or work friends only? If close-how long have you been close friends? show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Lowest
PX661201080000 [LOWEST IN PAST YEAR] Are they casual or more
close friends? If only casual-are they school or work friends only? If close-how long have you been close friends? show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Often_Current
PX661201020000 [CURRENT RATING] How often do you see more
friends? Do you see them outside of work/school? When was the ‘‘last time'' you saw one of your friends outside of work/school? (Attempt to determine ‘‘actual'' amount of social contact vs. percei show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Often_Highest
PX661201160000 [HIGHEST IN PAST YEAR] How often do you see more
friends? Do you see them outside of work/school? When was the ‘‘last time'' you saw one of your friends outside of work/school? (Attempt to determine ‘‘actual'' amount of social contact vs. show less
N/A
PX661201_SocialGlobal_Functioning_Friends_Often_Lowest
PX661201090000 [LOWEST IN PAST YEAR] How often do you see more
friends? Do you see them outside of work/school? When was the ‘‘last time'' you saw one of your friends outside of work/school? (Attempt to determine ‘‘actual'' amount of social contact vs. p show less
N/A
PX661201_SocialGlobal_Functioning_House_History
PX661201350000 (If a homemaker) How long have you been in more
charge of the home? show less
N/A
PX661201_SocialGlobal_Functioning_House_Hours
PX661201360000 (If a homemaker) How many hours per week do more
you spend working on household tasks? show less
N/A
PX661201_SocialGlobal_Functioning_House_Overwhelmed
PX661201370000 (If a homemaker) Are you able to keep up more
with the demands of your household? Do you ever fall behind? If so, are you able to catch up or do you need others' help? Are you avoiding any tasks? Do you need regular assistance or supervision for any tas show less
N/A
PX661201_SocialGlobal_Functioning_House_Responsibilities
PX661201340000 (If a homemaker) What are your more
responsibilities around the house or for the family? show less
N/A
PX661201_SocialGlobal_Functioning_House_Review
PX661201380000 (If a homemaker) Have you received any more
comments (positive or negative) regarding your performance? Have others pointed out things that you have done well or poorly? show less
N/A
PX661201_SocialGlobal_Functioning_Initiate_Contact_Current
PX661201030000 [CURRENT RATING] Do you usually initiate more
contact or activities with friends or do they typically call or invite you? Do you ever avoid contact with friends? show less
N/A
PX661201_SocialGlobal_Functioning_Initiate_Contact_Highest
PX661201170000 [HIGHEST IN PAST YEAR] Do you usually more
initiate contact or activities with friends or do they typically call or invite you? Do you ever avoid contact with friends? show less
N/A
PX661201_SocialGlobal_Functioning_Initiate_Contact_Lowest
PX661201100000 [LOWEST IN PAST YEAR] Do you usually more
initiate contact or activities with friends or do they typically call or invite you? Do you ever avoid contact with friends? show less
N/A
PX661201_SocialGlobal_Functioning_Job_Details
PX661201220000 (If currently working) Where do you work? more
What are your job responsibilities? show less
N/A
PX661201_SocialGlobal_Functioning_Job_Hours
PX661201230000 (If currently working) How many hours a week more
do you work? show less
N/A
PX661201_SocialGlobal_Functioning_Job_Overwhelmed
PX661201260000 (If currently working) Do you ever have more
trouble keeping up? Are you able to catch up if you fall behind? show less
N/A
PX661201_SocialGlobal_Functioning_Job_Review
PX661201270000 (If currently working) Have you received any more
comments (positive or negative) or formal reviews regarding your performance? Have others pointed out things that you have done well or poorly? show less
N/A
PX661201_SocialGlobal_Functioning_Job_Security
PX661201240000 (If currently working) How long have you more
been in your current job? Have you had any recent changes in your job status (e.g., lost job, stopped working, changed position, or workload) ? show less
N/A
PX661201_SocialGlobal_Functioning_Job_Supervision
PX661201250000 (If currently working) Do you usually need more
assistance or regular supervision at work? How often do you need extra help? Are there any tasks that you are not able to do alone? show less
N/A
PX661201_SocialGlobal_Functioning_School_Accommodations
PX661201310000 (If currently attending school) Do you more
receive any extra help or accommodations in your classes? Do you receive tutoring or extra help in school or after school? Do you receive extra time to take tests or are you able to leave the classroom to take t show less
N/A
PX661201_SocialGlobal_Functioning_School_Details
PX661201280000 (If currently attending school) What type of more
school do you attend? (general education, nonpublic school, residential/hospital) show less
N/A
PX661201_SocialGlobal_Functioning_School_Duration
PX661201300000 (If currently attending school) How long more
have you been at this school? Have you had any recent changes in your school placement? show less
N/A
PX661201_SocialGlobal_Functioning_School_Grades
PX661201330000 (If currently attending school) How are your more
grades? Are you failing any classes? show less
N/A
PX661201_SocialGlobal_Functioning_School_Overwhelmed
PX661201320000 (If currently attending school) Do you have more
trouble keeping up with your coursework? Are you able to catch up if you fall behind? show less
N/A
PX661201_SocialGlobal_Functioning_School_Special
PX661201290000 (If currently attending school) Have you more
ever been in special education classes or other non-general education classes? show less
N/A
PX661201_SocialGlobal_Functioning_Social_Life_Current
PX661201000000 [CURRENT RATING] Tell me about your social more
life. Do you have friends? show less
N/A
PX661201_SocialGlobal_Functioning_Social_Life_Highest
PX661201140000 [HIGHEST IN PAST YEAR] Tell me about your more
social life. Do you have friends? show less
N/A
PX661201_SocialGlobal_Functioning_Social_Life_Lowest
PX661201070000 [LOWEST IN PAST YEAR] Tell me about your more
social life. Do you have friends? show less
N/A
PX661201_SocialGlobal_Functioning_Time_Spent
PX661201210000 How do you spend your time during the day? N/A
Early Psychosis Translational Research
Measure Name

Social and Role Functioning in Psychosis and Schizophrenia

Release Date

January 17, 2017

Definition

An interview to assess global social and role functioning.

Purpose

This measure can be used to assess social, behavioral, and occupational difficulties associated with mental illness, including psychosis and schizophrenia, and track changes over time. These difficulties, which are often present before first hospitalization and diagnosis, are associated with neurocognitive problems and negative symptoms and can be resistant to antipsychotic medications, impeding long-term recovery.

Keywords

early psychosis, global functioning, social dysfunction, role dysfunction, prodrome, untreated psychosis, negative symptoms, neurocognitive problems

Measure Protocols
Protocol ID Protocol Name
661201 Social and Role Dysfunction in Psychosis and Schizophrenia
Publications

There are no publications listed for this protocol.