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 Functioning

The GAS and GAF have been ‘a standard’ to assess global functioning. The social and occupational functioning scale: SOFAS,16 which is a functional derivative of the GAF, has been described only sporadically. They are indeed quite simple and user-friendly but might be too simple to capture functional status. Ongoing efforts in this respect include the personal and social performance scale: PSP29 which modelled the SOFAS, and the functional assessment for comprehensive treatment in schizophrenia: FACT-Sz30 which is similar to the GAF but more detailed and more widely differentiates patients.

 

It has however been infrequent that functional scales, in contrast to symptomatic rating scales, have constituted the primary outcome measure in studies for schizophrenia,31-34 although global functioning appears to serve as a heuristic outcome that may represent ‘the net effect of everything’ in patients. Some studies on child and adolescent schizophrenia used the Children’s version of the GAS.35 On the other hand, global functioning scales specific for geriatric patients have not been reported, which would be all the more pertinent in light of a recent ageing society. However, complexity is how to define a ‘norm (or normal trajectory)’ with which any abnormality or deviance is compared in an aged population (Suzuki et al., submitted).

 

Performance-based scales, such as the UCSD Performance-Based Skills Assessment: UPSA,36 have not gathered much popularity thus far. This might be a result of the unfamiliarity of the performance-based scales despite a claim for their potential usefulness,37 but another important consideration is ‘what patients are actually doing’ versus ‘what patients can potentially do’. Performance-based assessment scales may more closely reflect the latter under a probable impact of cognitive capability, while other aspects such as motivation and mood may be more implicated in the former.38,39

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