M24. Assessing Functional Impairment in Treatment-Resistant Schizophrenia Using the Virtual Reality Functional Capacity Assessment Tool (VRFCAT): A Pilot Study

Abstract

Background: Assessment of functional capacity is vital in establishing an understanding of real world functioning in patients with cognitive impairment in schizophrenia. Most available tests of functional capacity are paper and pencil tests, or are not fully computerized. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT), developed by NeuroCog Trials, is a novel VR program, which provides a sequence of typical and real life community tasks. It offers ecological validity and complements the clinical assessment of functional capacity The aim of the present study was (1) to examine the feasibility of the VRFCAT in a population of very low functioning patients with Treatment resistance schizophrenia (TRS), (2) to relate the performance of the study patients to standardized VRFCAT per-formance data of higher functioning patients (Keefe et al,. 2016) and (3) to validate the performance level with other concurrent function measures. Methods: The VRFCAT creates a realistic, interactive, and immersive environment consisting of 4 scenarios: (1) exploring a kitchen, (2) catching a bus to a grocery store, (3) fnding/purchasing food in a grocery store, and (4) returning home on a bus. The VRFCAT was administered to 17 inpatients with DSM 5 diagnosis of schizophrenia and TRS, who were eligible for discharge from an inpatient psychiatric facility. Dependent variables included time to completion, number of errors on 12 tasks, and the number of times that an individual failed to complete a task. The SLOF, the UPSA-B and the PSP were also concurrently completed. The preliminary standardized sample of higher functioning patients consisted of 167 outpatients with DSM 5 diagnosis of schizophrenia, mean age 43.6 years (SD = 11.85) and level of education of 12.8 years (SD = 1.99). Results: All TRS patients enrolled were males with a mean age of 37.83 years (SD = 10.13). 41.18% of subjects also had a substance use diagnosis. The mean level of education in years was 10.88 (SD = 2.13) and 70.59% of patients had a history of incarceration. All patients completed the VRFCAT. TRS patients performed 2.5 SDs below total time (Mean T Score = 24.23, SD = 16.11), with total errors (T = 26.42, SD = 22.21), and 2 SDs below the mean for total progressions (T = 30.50, SD = 14.35). Pearson correlations for 4 of 12 VRFCAT objectives with PSP (r =.236; P =.223) and UPSA-B were statistically signifcant (UPSA-B communication r =.222; P =.232; UPSA-B Financial r =.356; P =.110). Conclusion: Results indicate that the VRFCAT is feasible in patients with TRS and delivers meaningful data. Functional defcits were robust in the TRS patients and generally 2 SDs below a population of higher function-ing patients. The validity of the VRFCAT was good in comparison with the UPSA and correlated well with the level of function. Future data will examine the predictive ability of the VRFCAT and community survival at 4 weeks after hospital discharge.