Social Competence, Social Cognition, Negative Symptoms, and Real-World Social Behavior as Predictors of Observer Rated Interpersonal Functioning in Schizophrenia and Bipolar Disorder: An Ecological Momentary Assessment Study.

BACKGROUND AND HYPOTHESIS: Impairments in interpersonal functioning are common across bipolar disorder (BD) and schizophrenia (SZ). Social competence and social cognition predict impairments in interpersonal functioning in participants with SZ, but the importance of negative symptoms and impairments in self-assessment of social cognition is also substantial. We expanded our previous research to include participants with BD and broadened the range of predictors to examine the importance of different predictors of interpersonal functioning. STUDY DESIGN: Participants with BD (n = 114) and SZ (n = 126) were evaluated. Interpersonal functioning was examined with observer ratings using the Specific Level of Functioning (SLOF). Predictors included performance-based measures of social competence, observer ratings and performance-based assessments of neurocognition and social cognition, clinically rated negative symptoms and depression, self-assessments of neurocognitive and social cognitive abilities, and data on moods, location, activities, and social context collected in a 30-day Ecological Momentary Assessment period. STUDY RESULTS: Negative symptoms were the best predictor of interpersonal functioning in both SZ and BD. In both groups, social competence and observer ratings of social cognition accounted for variance in interpersonal functioning, and depression was a significantly stronger predictor of interpersonal functioning in BD. CONCLUSIONS: Negative symptoms are strongly related to interpersonal functioning, but the pattern of correlations suggests that social cognition and social competence are likely to be important treatment targets across diagnoses. The lack of previous research on social competence in BD is under-scored by these results, with social skills training possibly having promise and a greater chance of success in BD.