Psychiatry Research 197 (2012) 290294

Contents lists available at SciVerse ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Psychometric properties of a performance-based measurement of functional

capacity, the UCSD Performance-based Skills Assessment - Brief version
Anna-Karin Olsson a, b,, Lars Helldin a, b, Fredrik Hjrthag a, b, Torsten Norlander b
a
b

NU Health Care, Department of psychiatry, SE-461 85 Trollhttan, Sweden

Department of psychology, Karlstad University, SE-651 88 Karlstad, Sweden

a r t i c l e

i n f o

Article history:
Received 18 November 2010
Received in revised form 29 July 2011
Accepted 1 November 2011
Keywords:
UPSA
Schizophrenia
Reliability
Validity
Assessment
Occupational performance

a b s t r a c t
The UCSD Performance-based Skills Assessment Brief version (UPSA-B) describes the functions of patients
without negative inuences of environmental factors such as unemployment or shortage in housing. The aim
of the present study is to further explore the psychometric properties of the UPSA-B as well as to ensure that
the Swedish version can be used in clinical practice and for research purposes. Participants were 211 patients,
135 men and 76 women, diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder. Results indicate that the UPSA-B is a reliable instrument with good psychometric properties regarding validity
and reliability. The instrument also had a capacity to reveal differences between various patient groups, both
diagnostic groups and groups based on remission status. The conclusion drawn is that the UPSA-B is a valuable instrument that could be used in future cross-national studies to describe the level of functioning for patients with schizophrenia and other psychotic illnesses.
2012 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Many patients with schizophrenia and other psychotic illnesses
continue to have difculties coping with everyday activities and functioning in society, despite successful pharmacological treatment. Research and long-term follow-ups on how these persons' functions
develop over time is a neglected realm (Carter, 2006). The ongoing
study Clinical Long-term Investigation of Psychosis in Sweden
(CLIPS) started at the end of the 1990s at the psychiatric clinic in
the NU-Healthcare Hospital, Trollhattan, Sweden. Today, the study includes more than 460 outpatients with psychotic illnesses. The purpose of the CLIPS is to annually collect data regarding several
illness-related factors, such as the patients' psychiatric symptoms,
side effects, social functioning, and quality of life.
The number of instruments measuring patients' function in everyday life is occupation is limited as compared to the number of instruments measuring cognitive functioning (Patterson et al., 2001). It is,
however, important to understand and describe the patients' ability
to perform activities, since there seems to be considerable variability
regarding this area. Some patients manage to perform at near-normal
level in some tasks, but most patients are impaired in several everyday activities (Fiszdon and Johannesen, 2010). The methods most frequently used to measure the patient's ability to perform everyday
activities are self-rating scales and reports from relatives and health
Corresponding author at: NU Health Care, Psykiatriska allvrdsenheten, Sdra
Strandvgen 19, 47334 SE-Henn, Sweden.
E-mail address: anna-karin.olsson@vgregion.se (A.-K. Olsson).
0165-1781/$ see front matter 2012 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2011.11.002

care staff (Moore et al., 2007). The patients' self-ratings provide valuable information, but are somewhat unreliable since the answers to a
great extent are inuenced by the patient's self-awareness, cognitive
functioning, symptoms, and emotional status (Atkinson et al., 1997).
By obtaining information from the patient's relatives, knowledge
about the patient's situation increases. Unfortunately, it is often difcult to get the patient to list relatives who can provide this kind of information (Patterson et al., 2001). According to Hamera and Brown
(2000), investigations of patients' ability to cope with everyday life
in their natural environment give a reliable picture of the patients'
functional capacity. This form of assessment is, however, considered
to be too expensive, as well as too time- and personnel-consuming,
to be used in larger studies (Patterson et al., 2001).
Some performance-based skills assessments measure functional
capacity, dened as the patients' ability to perform daily activities
under optimal conditions, which is not always equivalent to their performance in real life. This means that patients' functional capacity can
be assessed in clinics, in a controlled environment, through role-plays
and various everyday tasks (Patterson et al., 2001; McKibbin et al.,
2004). One of the performance-based instruments used more often
in studies together with cognitive tests, and which is recommended
by Measurement and Treatment Research to Improve Cognition in
Schizophrenia (MATRICS), is the University of California, San Diego
(UCSD), Performance-based Skills AssessmentUPSA (McKibbin et
al., 2004). The instrument was developed at the Department of Psychology, and has been translated into over 20 different languages.
Today, the instrument is used in more than 22 countries (Mausbach
et al., 2007). The purpose of the UPSA is to measure the functional

A.-K. Olsson et al. / Psychiatry Research 197 (2012) 290294

capacity of persons with a severe mental illness. The UPSA consists of

role-play tasks that capture the complexity of everyday tasks
(Patterson et al., 2001). Statistical analyses have shown that the
UPSA has a high correlation with tests measuring cognitive function,
personal care, and social and communicative skills (Twamley et al.,
2002; Bowie et al., 2006). Furthermore, studies have shown that the
instrument can be used to predict if the patients have the ability to
live independently (Twamley et al., 2002; Mausbach et al., 2007).
The UPSA-Brief (UPSA-B) is a shortened version of the full UPSA,
and was derived from, and developed through, factor analysis. One
of the advantages of the UPSA-B is that the assessment itself does
not take more than 1015 min, which is a positive factor for both
test administrators and patients, especially since some persons with
a psychotic illness have difculties keeping their attention focused
for any length of time (Mausbach et al., 2007). According to previous
research, the UPSA-B is one of the instruments that ought to be more
frequently used in research on persons with psychotic illnesses
(McClure et al., 2007). The aim of the present study was to further explore the psychometric properties of the UPSA-B as well as to ensure
that the Swedish version can be used in clinical practice and for research purposes.

2. Method
2.1. Procedure
Data were collected within the study Clinical Long-term Investigation of Psychosis
in Sweden (CLIPS). Within the project, health care staff assessed patients yearly in
order to evaluate, among other things, mental status, psychiatric symptoms, side effects, social functioning, satisfaction regarding care-giving and quality of life. Also,
the patient was given the opportunity to see an occupational therapist for further examination using the UPSA-B. During the period February 2007 to August 2009, a
total of 211 patients chose to see an occupational therapist, and assessments were administered according to the guidelines of the Swedish manual for the UPSA-B. When all
patients included in the entire CLIPS sample were compared to the 211 patients of the
present study regarding sex, age, housing, ability to work, and social contacts, the two
groups did not differexcept regarding sex. The entire CLIPS sample was more evenly
distributed, 57% men and 43% women, whereas this study included 64% men and 36%
women. Of the 211 patients assessed with the Swedish version of the UPSA-B, 80 patients
were reassessed with the same instrument after approximately 1 year; on average, it was
11.88 months (S.D.=1.49, range=9 to 15) between the assessments.

2.2. Participants
The participants consisted of 135 men and 76 women with a mean age of
49.18 years (S.D. = 11.62, range = 23 to 74). Of these, 137 patients were diagnosed
with schizophrenia, 45 patients were diagnosed with schizoaffective disorder, and 29
patients with delusional disorder according to DSM-IV (Table 1).
During the rst UPSA-B assessment, 110 patients were in remission and 101 were
not in remission. Regarding marital status, 177 patients were single and 34 were married or cohabiting. It appeared that 141 patients lived alone, 49 lived together with
partner/family, 16 lived in sheltered housing and ve lacked a permanent address. Regarding nancial status, 144 patients had a pension, 24 were unemployed, 14 worked
part-time and 12 worked full-time. Furthermore, 10 patients had sheltered work, one
studied, and six patients had some kind of volunteer occupation. Analyses (Independent Samples t-test, 5% level) showed no signicant differences between the sexes,
neither regarding age nor regarding scores on the UPSA-B. Furthermore, a chi-square
test showed that there was no difference in remission with regard to sex. A subset, approximately 140 of the 211 participants, participated in a recent cross-national study
(Harvey et al., 2009a), where the UPSA-B was used to collect data considering schizophrenia patients living in Sweden and New York.

Table 1
Demographic characteristics of participants divided into the diagnostic groups.

Gender, male/female
Age, Mean/S.D.
Remission status
1st UPSA-B, yes/no

Schizophrenia,
n = 137

Schizoaffective
disorder, n = 45

Delusional
disorder, n = 29

103/34
48.88/10.78
64/73

18/27
47.33/11.79
27/18

14/15
53.45/14.32
19/10

291

2.3. Instruments
2.3.1. UCSD Performance-Based Skills Assessment- Brief (UPSA-B) (Patterson et al., 2001)
The instrument is a shortened version of the UCSD Performance-based Skills Assessment (UPSA), which was developed in order to assess the capacity of persons
with psychotic illnesses to adequately perform skills necessary for everyday activities.
The tasks are carried out in a controlled environment (Patterson et al., 2001). The
UPSA-B showed satisfactory psychometric properties, predicted ability to live on
one's own, was sensitive to change, and only took 1015 min to administer
(Mausbach et al., 2007).
In this study, the original version of the UPSA-B was translated and adjusted to
Swedish conditions. Permission to translate and adjust the UPSA-B was obtained
from Patterson and Goldman, who developed the original instrument. The rst part
of the UPSA-B consists of tasks that require nancial skills: to count money and pay
bills. When translating and adjusting the instrument, it was considered that the
sums were to contain as many bills and coins as in the original version. Thereafter,
the participants receive a bill and are asked to show how to ll in a check in the original
version. A bank transfer form, which in Sweden is commonly used for paying bills,
replaced the check in the Swedish version; both versions require that the participants
ll out the name of the company, invoice number, own name and sum.
The second part consists of tasks that require communication skills. Participants
are provided with an unplugged telephone and are asked to demonstrate how they
carry out a number of phone calls. First, they are asked to use the telephone to call
for help in an emergency situation (911 in the original version and 112 in the Swedish
version). Another task involves dialing a phone number, from memory, read by the test
administrator (569-9669 in the original version and 056-96 69 94 in the Swedish version). After that, the participants get to read through a medical appointment conrmation letter and are then asked to call and reschedule the appointment. The nal task
requires that the participants remember what they have read in the letter regarding
how to prepare for the medical appointment and the medical tests. In total, the score
of the UPSA-B can range from 0 to 19 points.
The translation into Swedish was done according to an established procedure with
translation and retranslation (Jones, 1986). Two persons, from the CLIPS study staff,
did the adaptation of the instrument into Swedish conditions in order to obtain a
level of difculty similar to the original version. The entire original manual was given
to an authorized translator, and then the Swedish version was sent to another translator for a retranslation. The retranslated version did not contain any considerable linguistic differences compared to the original version. In a recent cross-national study
(Harvey et al., 2009a), both the Swedish version and the original version of the
UPSA-B were used to collect data from schizophrenia patients living in Sweden and
New York. Performances on the UPSA-B were basically identical for the two samples, indicating that the level of difculty in the Swedish version is similar to the original
version.
2.3.2. StraussCarpenter scale (modied version) (Strauss and Carpenter, 1972)
The original StraussCarpenter scale was modied by Lindstrm et al. (1995). The
modied version consists of questions regarding living conditions, social contacts, ability to work and number of days in sheltered housing (Lindstrm et al., 1995). Information was collected from medical chart, as well as from interviews with patients,
relatives and medical staff.
2.3.3. Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1987)
Patients were interviewed by nursing staff following a Swedish translation of the
Structured Clinical Interview Positive and Negative Syndrome Scale (SCI-PANSS)
(Lindstrm et al., 1994). The patients' answers on the interview questions form the
basis for scoring on 30 items. By using eight specic items from the PANSS (three positive, three negative and two general symptoms), the patients considered to be in remission can be identied. These items were chosen since they represent the most
central symptoms of schizophrenia according to DSM-IV and ICD-10. Symptom remission means that the patient has been in a stable phase for the past 6 months and has
not had more than moderate symptoms that do not interfere with thinking, social relations, or behavior (i.e., not more than 3 points out of 7 possible). (Kane et al., 2003;
Andreasen et al., 2005; van Os et al., 2006). In this study, 110 patients were in remission and 101 patients were not.
2.3.4. Global Assessment of Functioning Scale (GAF) (Luborsky, 1962)
The instrument assesses global mental health based on mental, social and functional capacity. The GAF consists of two scales (one for symptoms and one for function). Each scale has 100 steps, where score 1 represents the most severe illness
condition and 100 means that the person is completely free from functional disability
and symptoms, i.e., not only free from mental dysfunction (American Psychiatric
Association, 1994). In the present study, only scores from the scale measuring functional capacity were used.
2.3.5. The Specic Level of Functioning Assessment Scale (SLOF) (Schneider and Struening, 1983)
The instrument is used for describing the observable roles and functions of patients, and consists of 43 statements within the following areas: physical functioning,
ability to take care of one's self, interpersonal relations, social acceptance, activities
and capacity to work. The statements are assessed on ve-point scales where high
scores signify that the patient can cope more independently, while low scores indicate

292

A.-K. Olsson et al. / Psychiatry Research 197 (2012) 290294

that the patient is more help dependent. The reliability of the instrument has been
tested via a homogeneity test that shows acceptable values (from 0.59 to 0.83)
(Schneider and Struening, 1983). In the present study, the patient's case manager as
well as a relative independently lled out the questionnaire.
2.3.6. The Assessment of Communication and Interaction Skills (ACIS) (Forsyth et al., 1999)
This is an observational instrument rating a person's communication and interaction
skills with other persons in some form of social activities. The Swedish version of the
ACIS has shown good validity and reliability (Kjellberg et al., 2003). In the present study,
the assessment situation was a dyadic interaction between the patient and the occupational therapist, where the patient was asked to describe an ordinary day.
2.4. Design
The psychometric properties of the UPSA-B were examined by studying both its
validity and its reliability. To validate the Swedish version of the UPSA-B, a number
of well-established instruments with known psychometric properties were chosen
from the vast test battery used at the annual medical examination (CLIPS). The assessment instruments selected to study concurrent validity were the StraussCarpenter
scale, the Global Assessment of Functioning Scale (GAF), the Specic Level of Functioning Scale (SLOF) and The Assessment of Communication and Interaction Skills (ACIS).
Furthermore, the Positive and Negative Syndrome Scale (PANSS) was used to establish
whether the patient was in remission or not in order to determine if the UPSA-B could
differentiate between the two levels of symptomatic status. The discriminant validity
was also studied by comparing the three different diagnostic groups, schizophrenia,
schizoaffective disorder, and delusional disorder.
In order to investigate the reliability for the UPSA-B, a homogeneity test (Cronbach's
Alpha) was done, and testretest correlations were calculated between the results from
the rst and second measures of the participants assessed with the UPSA-B on two occasions.

3. Results
3.1. Validity
3.1.1. Concurrent validity
Concurrent validity was examined by correlating (Pearson's r) the
total score of the UPSA-B and the subscales Finance and Communication scores with the scores for the following instruments: Strauss
Carpenter, GAF, SLOF (by health care staff), SLOF (by relatives), and
ACIS. Table 2 shows the mean values and standard deviations, as
well as the lowest and highest score for the UPSA-B and the functional
assessment instruments used to examine the validity.
The results of the correlations (Pearson's r) show signicant correlations between the total score on the UPSA-B and the areas of
housing, ability to work, and social contacts, as measured with the
StraussCarpenter scale (see Table 3). The results indicated
Table 2
Mean values and standard deviations, as well as lowest and highest score for the UPSAB and the functional assessment instruments used to examine validity for the UPSA-B.
M
UPSA-B (n = 211)
Total
Finance
Communication
GAF
Function (n = 207)
StraussCarpenter (n = 211)
Housing
Ability to work
Social contacts
Days in sheltered housing
SLOF, health care staff
Total sum (n = 169)
SLOF, relative
Total sum (n = 52)
ACIS
Total sum (n = 120)

13.27
7.76
5.51

S.D.
3.73
2.32
1.92

Min/max
0/19
0/10
0/9

signicant correlations (r = 0.37 to 0.50) between total score on the

UPSA-B and total scores on the other measuring instruments.
3.1.2. Discriminant validity
Discriminant validity was examined using a one-way ANOVA with
the total score on the UPSA-B, collected at the rst measurement occasion, as a dependent variable and remission status (remission and
non-remission) as an independent variable. The analysis showed a
signicant difference [F (1, 209) = 10.39, p = 0.001] where patients
in remission had a higher mean value on the total score on the
UPSA-B (M = 14.05, S.D. = 3.17) as compared to those not in remission (M = 12.43, S.D. = 4.11). Equivalent ANOVAs were conducted
with the subscores, Finance and Communication, as dependent variables. Here too, the analyses showed signicant differences regarding
the subscores for Finance [F (1, 209) = 9.17, p = 0.003] and for Communication [F (1, 209) = 6.59, p = 0.011]. Concerning the subscores
for Finance, patients in remission performed at higher mean
(M = 8.22, S.D. = 1.91) as compared to those not in remission
(M = 7.27, S.D. = 2.62) and on the subscore for Communication, patients in remission also performed at higher mean (M = 5.83,
S.D. = 1.70) as compared to those not in remission (M = 5.16,
S.D. = 2.08).
Further, it was examined if UPSA-B results collected during the
rst measurement occasion could detect differences regarding different diagnostic groups. A one-way ANOVA was conducted with total
score on UPSA-B as a dependent variable, and diagnostic group
(schizophrenia, schizoaffective disorder, and delusional disorder) as
an independent variable. Analysis showed a signicant outcome
[F(2, 208) = 3.43, p = 0.034]. An additional post-hoc test (TukeyHSD) revealed that patients diagnosed with schizophrenia have a
somewhat lower mean score on the total score on the UPSA-B
(M = 12.79, S.D. = 4.04) as compared to those who have the diagnosis
schizoaffective disorder (M = 14.31, S.D. = 3.08). Analyses found no
signicant differences between those diagnosed with delusional disorder as compared to the two other diagnostic groups. Similar oneway ANOVAs were then carried out with the subscores for Finance
and Communication as dependent variables. These did not, however,
show any signicant differences.
3.2. Reliability
3.2.1. Homogeneity
The homogeneity of the instrument regarding the domains Finance (counting money and making change, paying bills) and Communication was analyzed with Cronbach's Alpha. Analyses gave
Table 3
Correlations (Pearson's r) between the UPSA-B and the instruments that assess functional capacity.
UPSA-B
Total
GAF Function (n = 207)

47.56

3.77
1.50
3.48
27.16

184

191

63.68

8.01

0.60
0.88
0.76
95.11

17.33

22.20

11.59

Finance

Communication

0.30**

0.28**

0.25**

0.27**
0.27**
0.25**
0.24**

0.32**
0.24**
0.28**
0.27**

0.13
0.24**
0.14*
0.13

SLOF, health care staff

Total sum (n = 169)

0.41**

0.41**

0.29**

SLOF, relative
Total sum (n = 52)

0.50**

0.51**

0.40**

ACIS Total sum (n = 116)

0.37**

0.36**

0.33**

33/75

1/4
1/4
1/4
0/365

StraussCarpenter (n = 211)
Housing
Ability to work
Social contacts
Days in sheltered housing

132/215

112/215

33/80

** Correlation is signicant on the 0.01 level (2-tailed).

* Correlation is signicant on the 0.05 level (2-tailed).

A.-K. Olsson et al. / Psychiatry Research 197 (2012) 290294

Alpha scores of 0.59 on counting money and making change (4

items), 0.77 on paying bills (6 items) and 0.59 on communication (9
items).
3.2.2. Testretest reliability
Signicant correlations were found between the rst and second
measurements for the 80 participants assessed on the UPSA-B on
two occasions, i.e., Total (r = 0.73; p b 0.01), Finance (r = 0.63;
p b 0.01) and Communication (r = 0.64; p b 0.01). If the groups are divided according to remission status, the correlations between the rst
and second measurements on the UPSA-B total score were r = 0.58
(p b 0.01) for the group in remission during both measurements
(n = 47), r = 0.83 for the group that was not in remission during
any of the measurements (n = 33).
4. Discussion
The main result of the current study is that the Swedish version of
UPSA-B is a reliable instrument with good psychometric properties
regarding both validity and reliability. The instrument showed significant correlations with several established instruments used to assess
patients' functional capacity. Also, the instrument showed capacity to
discover differences between various groups, especially differences in
level of remission status and also in a lower degree between diagnostic groups, indicating that the instrument is sensitive enough to measure and describe changes. A homogeneity test showed acceptable
results, and also acceptable to high correlations were noted at the
testretests.
In order to validate the UPSA-B, a number of well-established instruments were used that measure patients' ability to perform everyday activities. These instruments have different designs but still
correlated signicantly (p b 0.01) with the UPSA-B, with r-values
ranging from approximately 0.2 to 0.5. These ndings not only indicate that the UPSA-B is rmly anchored within the functional capacity
realm, but also that the UPSA-B seems to contribute new information
to the realm. In an earlier study, concurrent validity of the UPSA-B
was studied through the use of cognitive tests and symptom rating
scales, and not by other functional assessments (Mausbach et al.,
2007). The correlations between the UPSA-B and tests that measure
cognitive functions such as attention, memory, and construction etcetera were signicant, ranging from r = 0.12 to r = 0.57. Results
also suggest that negative symptoms have a higher covariation with
the UPSA-B than have positive symptoms (Mausbach et al., 2007).
Since earlier studies validating the UPSA-B by related functional assessments are missing, our results could not be directly compared
to previous ndings. The conclusions are, however, still the same;
namely that the UPSA-B is a useful assessment in order to elucidate
patients' capacity to perform everyday activities.
The UPSA-B has, together with the assessment scale SLOF, been
used in several studies (Harvey et al., 2009b; Mausbach et al.,
2010). The study by Mausbach et al. (2010) showed signicant correlations with r-values ranging from approximately 0.3 to approximately 0.6 between the UPSA-B total score and the the SLOF
domains (i.e., personal care skills, social acceptability, activities and
work skills). The present study showed signicant correlations between the UPSA-B and SLOF total scores; 0.4 when the SLOF was
assessed by a case manager, and 0.5 when the assessment was
done by a relative. This indicates that different instruments are needed, but also that information from different persons is needed in
order to obtain a comprehensive picture of the patient's capacity to
perform everyday tasks. The latter has also been observed in previous research (Hjrthag et al., 2012).
When discriminant validity was examined in this study, it turned out
that the Swedish version of the UPSA-B has the sensitivity to measure
variation with regard to both remission status and between diagnostic
groups. Patients diagnosed with schizophrenia had a somewhat lower

293

mean value on the total score compared to those diagnosed with schizoaffective disorder. In an earlier study, however, differences between
the diagnoses schizophrenia and schizoaffective disorder could not be
demonstrated in this regard (Twamley et al., 2002). Possible explanations could be that the groups in these two studies differ regarding number of individuals, symptom severity and age. The conclusion drawn is
that further studies are needed that take into consideration and describe
more aspects within the various diagnostic groups.
Previous research has shown that there is an overlap regarding
functional capacity between groups with different remission statuses
when it comes to coping with everyday activities. Some patients who
are not in remission can have the same (or even higher) functional
capacity as patients in remission (Helldin et al., 2007). The result of
the present study shows that the patients who were in remission at
both test occasions have a slightly higher result on the UPSA-B. It is
therefore important to further investigate the inuence of symptoms
on patients' functional capacity. Factors that might interact and be
relevant in this regard are, for instance, neurocognition, illness duration and the illness onset age.
An earlier study tested the reliability of the UPSAthe original instrumentby measuring its inter-rater reliability (Patterson et al.,
2001). In a recent study, a testretest was conducted on 87 patients
after 6, 12, and 18 months (Leifker et al., 2010). The result after
12 months showed signicant testretest correlations for the total
sum of the UPSA-B (r = 0.81; p b 0.01), which is comparable with
the result of this study (r = 0.73; p b 0.01). The homogeneity test in
the present study showed acceptable values ranging from 0.59 to
0.77 (Cronbach's Alpha). Streiner and Norman (2003) argue that a reliable alpha coefcient should be 0.8 or higher, but values higher than
0.5 are considered acceptable. One explanation for the lower value regarding homogeneity in the subdomain counting money and making
changewithin the domain Financecould be that these tasks include a clear progression from easier to more difcult tasks.
A question for further research is whether patients who are in remission for longer periods of time have a greater learning capacity
(Helldin et al., 2007). The results of this study showed lower correlation between the measurement occasions for the group in stable remission; this might be a consequence of learning from the rst
assessment.
A limitation of this study could be the selection of instruments
used to measure concurrent validity. At the same time, this study
brings new knowledge into the area based on the selection of our instruments. The participants in this study are in a stable phase of their
illness during the assessment occasions, which means that symptoms
are limited to a certain extent. The range of symptom severity thereby
shrinks, which, in turn, puts higher demands on the data in order to
detect differences in, for example, discriminant validity. Also, there
might have been other patterns of differences seen if we had compared the UPSA-B results from participants in this study with those
of persons from other diagnostic groups such as autistic syndrome,
Asperger syndrome, or if, as in the study of Mausbach et al. (2010),
people with schizophrenia had been compared with people diagnosed with bipolar disorder. Future follow-ups may elucidate these
possible differences.
As previously pointed out, the current study shows that the Swedish version of the UPSA-B has satisfactory psychometric properties.
The outcome of this study stresses the importance of forthcoming
studies that cover how the UPSA-B can assess the functional capacity
of patients with schizophrenia and other psychotic illnesses on a
more detailed level.
Acknowledgements
The study was approved by the Ethical Research Committee at
Gteborg University, Sweden, and was supported by unrestricted grants
from Janssen-Cilag AB, Sollentuna, Sweden. Authors acknowledge the

294

A.-K. Olsson et al. / Psychiatry Research 197 (2012) 290294

excellent technical assistance of Veronica Ahl, Britt-Marie Hansson,

Ruth Johansson, and Maivor Olsson.
References
American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental
Disorder, 4th ed. APA, Washington, DC.
Andreasen, N.C., Carpenter, W., Kane, J.M., Lasser, R.A., Marder, S.R., Weinberger, D.R.,
2005. Remission in schizophrenia: proposed criteria and rationale for consensus.
The American Journal of Psychiatry 162, 441449.
Atkinson, M., Zibin, S., Chuang, H., 1997. Characterizing quality of life among patients
with chronic mental illness: a critical examination of a self-report methodology.
The American Journal of Psychiatry 154, 99105.
Bowie, C.R., Reichenberg, A., Patterson, T.L., Heaton, R.K., Harvey, P.D., 2006. Determinants of real-world functioning performance in schizophrenia: correlations with
cognition, functional capacity and symptoms. The American Journal of Psychiatry
163, 418425.
Carter, C.S., 2006. Understanding the glass ceiling for functional outcome in schizophrenia. The American Journal of Psychiatry 163, 356358.
Fiszdon, J.M., Johannesen, J.K., 2010. Functional signicance of preserved affect recognition in schizophrenia. Psychiatry Research 176, 120125.
Forsyth, K.A., Lai, J.S., Kielhofner, G., 1999. The assessment of communication and interaction skills (ASIS): measurement properties. British Journal of Occupational Therapy 62, 6974.
Hamera, E., Brown, C.E., 2000. Developing a context based performance measure for
persons with schizophrenia: the test of grocery shopping skills. American Journal
of Occupational Therapy 54, 2025.
Harvey, P.D., Helldin, L., Bowie, C.R., Heaton, R.K., Olsson, A.K., Hjrthag, F., Norlander,
T., Patterson, T.L., 2009a. Performance-based measurement of functional disability
in schizophrenia: a cross-national study in the United States and Sweden. The
American Journal of Psychiatry 166, 821827.
Harvey, P.D., Keefe, R.S.E., Patterson, T.L., Heaton, R.K., Bowie, C.R., 2009b. Abbreviated
neuropsychological assessment in schizophrenia: prediction of different aspects of
outcome. Journal of Clinical and Experimental Neuropsychology 31, 462471.
Helldin, L., Kane, J.M., Karilampi, U., Norlander, T., Archer, T., 2007. Remission in prognosis of functional outcome: a new dimension in the treatment of patients with
psychotic disorders. Schizophrenia Research 93, 160168.
Hjrthag, F., Helldin, L., Olsson, A.-K., Norlander, T., 2012. Family burden and functional
assessment in the Swedish CLIPS-study: do staff and relatives agree on individuals
with psychotic disorders' functional status? Social Psychiatry and Psychiatric Epidemiology 47, 581587.
Jones, E., 1986. Translation of quantitative measures for use in cross-cultural research.
Nursing Research 36, 324327.
Kane, J.M., Leucht, S., Carpenter, D., Docherty, J.P., 2003. Expert consensus guidelines
series. Optimizing pharmacologic treatment of psychotic disorders. Introduction:
methods, commentary, and summary. The Journal of Clinical Psychiatry 64, 519.
Kay, S.R., Fitzbein, A., Opler, L.A., 1987. The positive and negative syndrome scale
(PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261267.

Kjellberg, A., Haglund, L., Forsyth, K., Kielhofner, G., 2003. The measurement properties
of the Swedish version of the Assessment of Communication and Interaction Skills.
Scandinavian Journal of Caring Sciences 17, 271277.
Leifker, F.R., Patterson, T.L., Bowie, C.R., Mausbach, B.T., Harvey, P.D., 2010. Psychometric properties of performance-based measurements of functional capacity: test
retest reliability, practice effects, and potential sensitivity to change. Schizophrenia
Research 119, 246252.
Lindstrm, E., Wieselgren, I.M., von Knorring, L., 1994. Interrater reliability of the structured clinical interview for the positive and negative syndrome scale for schizophrenia. Acta Psychiatrica Scandinavica 89, 192195.
Lindstrm, E., Eriksson, B., Hellgren, A., von Knorring, L., Eberhard, G., 1995. Efcacy
and safety of Risperidone in the long-term treatment of patients with schizophrenia. Clinical Therapeutics 17, 402412.
Luborsky, L., 1962. Clinician's judgments of mental health: a proposed scale. Archives
of General Psychiatry 7, 407417.
Mausbach, B.T., Harvey, P.D., Goldman, S.R., Jeste, D.V., Patterson, T.L., 2007. Development of a brief scale of everyday functioning in persons with serious mental illness.
Schizophrenia Bulletin 33, 13641372.
Mausbach, B.T., Harvey, P.D., Pulver, A.E., Depp, C.A., Wolyniec, P.S., Thornquist, M.H.,
McGrath, J.A., Bowie, C.R., Patterson, T.L., 2010. Relationship of the brief UCSD
Performance-based skills Assessment (UPSA-B) to multiple indicators of functioning in people with schizophrenia and bipolar disorder. Bipolar Disorders 12, 4555.
McClure, M.M., Bowie, C.R., Patterson, T.L., Heaton, R.K., Weaver, C., Anderson, H.,
Harvey, P.D., 2007. Correlation of functional capacity and neuropsychological performance in older patients with schizophrenia: evidence for specicity of relationships? Schizophrenia Research 89, 330338.
McKibbin, C., Patterson, T.L., Jeste, D.V., 2004. Assessing disability in older patients with
schizophrenia: result from the WHODAS-II. Journal of Nervous and Mental Disorders 192, 405413.
Moore, D.J., Palmer, B.W., Patterson, T.L., Jeste, D.V., 2007. A review of performance
based measures of functional living skills. Journal of Psychiatry Research 41,
97118.
Patterson, T.L., Goldman, S., McKibbin, C.L., Hugs, T., Jeste, D.V., 2001. USCD performance based skills assessment: development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin 27, 235245.
Schneider, L.C., Struening, E.L., 1983. SLOF: a behavioral rating scale for assessing the
mentally ill. Social Work Research & Abstracts 19, 921.
Strauss, J.S., Carpenter, W.T., 1972. The prediction of outcome in schizophrenia, I, Characteristics of outcome. Archives of General Psychiatry 27, 739746.
Streiner, D.L., Norman, G.R., 2003. Health Measurement Scales: A Practical Guide to
Their Development and Use, 3th ed. Oxford University Press, Oxford.
Twamley, E.W., Doshi, R.R., Nayak, G.V., Palmer, B.W., Golshan, S., Heaton, R.K.,
Patterson, T.L., Jeste, D.V., 2002. Generalized cognitive impairments, ability to perform everyday tasks, and level of independence in community living situation of
older patients with psychosis. The American Journal of Psychiatry 159, 20132020.
van Os, J., Burns, T., Cavallaro, R., Leucht, S., Peuskens, J., Helldin, L., Bernardo, M.,
Arango, C., Fleischhacker, W., Lachaux, B., Kane, J.M., 2006. Standardized remission
criteria in schizophrenia. Acta Psychiatrica Scandinavica 113, 9195.