Exploring early discontinuation of mental health outpatient treatment: language, demographics and clinical characteristics among migrant populations in Japan.

BACKGROUND: The fast-growing migrant population in Japan and globally poses challenges in mental healthcare, yet research addressing migrants' mental health treatment engagement remains limited. OBJECTIVE: This study examined language proficiency, demographic and clinical characteristics as predictors of early treatment discontinuation among migrants. METHODS: Electronic health record data from 196 adult migrants, identified from 14 511 patients who received mental health outpatient treatment during 2016 and 2019 at three central hospitals in the Tokyo-Yokohama metropolitan region of Japan, were used. We conducted multivariable regression models to identify predictors of early discontinuation within 3 months. FINDINGS: The study cohort (65% women, age range: 18-90 years, from 29 countries or regions) included 23% non-Japanese speakers. Japanese and non-Japanese speakers had similar discontinuation rates (26% vs 22%). Multivariable models revealed younger age (OR=0.97; 95% CI: 0.95, 0.99; p=0.016) and those with a primary diagnosis other than a schizophrenia spectrum disorder (OR=3.99; 95% CI: 1.36, 11.77; p=0.012) or a neurotic, stress-related and somatoform disorder (OR=2.79; 95% CI: 1.14, 6.84; p=0.025) had higher odds of early discontinuation. These effects were more pronounced among the Japanese speakers with significant language-by-age and language-by-diagnoses interactions. CONCLUSION: Younger age and having a primary diagnosis other than a schizophrenia spectrum disorder or a neurotic, stress-related and somatoform disorder increased vulnerability for discontinuing mental health treatment early in Japanese-speaking migrants but not for migrants with limited Japanese proficiency. CLINICAL IMPLICATIONS: Understanding language needs within a context of mental health treatment should go beyond assumed or observed fluency. Unmet language needs might increase vulnerability for treatment disengagement among migrants. Targeted clinical efforts are crucial for enhancing early treatment engagement and informing health practices in Japan and countries with growing migrant populations.

Exploring the impact of biological alterations in the superior thalamic radiations on exploratory eye movements in attenuated psychosis syndrome.

Introduction: Aberrant fixation and scan paths in visual searches have been repeatedly reported in schizophrenia. The frontal eye fields (FEF) and thalamus may be responsible for fixation and scan paths. These two regions are connected by superior thalamic radiation (STR) in humans. Studies have reported reduced fixation numbers and shortened scan path lengths in individuals with attenuated psychosis syndrome (APS) and schizophrenia. In this study, we hypothesized that STRs in the white matter fiber bundles of impairments underlie abnormalities in fixation and scan path length in individuals with APS. Methods: Twenty-one individuals with APS and 30 healthy controls participated in this study. All participants underwent diffusion tensor imaging, and fractional anisotropy (FA) values of the left and right STR were analyzed using the novel method TractSeg. The number of eye fixations (NEF), total eye scanning length (TESL), and mean eye scanning length (MESL), derived using the exploratory eye movement (EEM) test, were adopted to evaluate the fixation and scan path length. We compared the FA values of the bilateral STR and EEM parameters between the APS and healthy control groups. We investigated the correlation between bilateral STR and EEM parameters in the APS and healthy control groups. Results: NEF, TESL, MESL, and the FA values of the left STR were significantly reduced in individuals with APS compared to healthy controls. The left STR FA value in the APS group was significantly positively correlated with the MESL (r = 0.567, p = 0.007). In addition, the right STR FA value of the APS group was significantly correlated with the TESL (r = 0.587, p = 0.005) and MESL (r = 0.756, p = 0.7×10-4). Discussion: These results demonstrate that biological changes in the STR, which connects the thalamus and FEF, underlie abnormalities in fixation and scanning. Recently, aberrations in the thalamus-frontal connection have been shown to underlie the emergence of psychotic symptoms. STR impairment may be a part of the biological basis of APS in individuals with subthreshold psychotic symptoms.

The evaluation study for social cognition measures in Japan: Psychometric properties, relationships with social function, and recommendations.

AIM: Patients with schizophrenia can have significant subjective difficulties in social cognition, but few undergo testing or treatment for social cognition. The Social Cognition Psychometric Evaluation (SCOPE) study recommends six social cognitive measures; however, the reliability and validity of these measures in different cultural and linguistic areas has not been adequately examined. We examined the psychometric properties of nine social cognitive measures and the relationship to social function, with the aim of determining the level of recommendation for social cognitive measures in clinical practice in Japan. METHODS: For our test battery, an expert panel previously selected nine measures: the Bell Lysaker Emotion Recognition Task (BLERT); Facial Emotion Selection Test (FEST); Hinting Task (Hinting); Metaphor and Sarcasm Scenario Test (MSST); Intentionality Bias Task (IBT); Ambiguous Intentions and Hostility Questionnaire (AIHQ); Social Attribution Task-Multiple Choice (SAT-MC); SAT-MCII; and Biological Motion (BM) task. In total, 121 outpatients with schizophrenia and 70 healthy controls were included in the analysis, and the results were provided to an expert panel to determine the recommendations for each measure. The quantitative psychological indices of each measure were evaluated for practicality, tolerability, test-retest reliability, correlation with social function, and the incremental validity of social function. RESULTS: Hinting and FEST received the highest recommendations for use in screening, severity assessment, and longitudinal assessment, followed by BLERT, MSST AIHQ, SAT-MC, and SAT-MCII, with IBT and BM receiving the lowest recommendations. CONCLUSION: This study provides a uniform assessment tool that can be used in future international clinical trials for social cognitive impairment.

Perceptions and attitudes of users and non-users of mental health services concerning mental illness and services in Japan.

Objectives: There is a global movement to develop and implement community-based integrated mental health systems. The present study attempted to clarify the perceptions and attitudes of users and non-users of mental health services concerning mental illness and services in Japan. Methods: A new questionnaire was developed for this internet survey. Data from 500 outpatients with depression and 500 healthy subjects were sampled according to the demographics of the Japanese population. Results: Over 90% of healthy subjects and over 70% of patients were unaware of the common age of onset or lifetime prevalence of mental illness. Over 90% of the healthy subjects and about 70% of the patients could not describe any services where they would feel comfortable discussing mental health problems. In both groups, "adolescents and young adults" were ranked first as a target population for mental health and illness policies. The top requirement for the integrated care systems was the promotion and awareness of correct knowledge of mental illness in both the healthy subjects and patients. Conclusion: Societal requirements could include disseminating correct knowledge, awareness-raising actions for society, and implementing services where people, especially young people, can easily consult and receive support in the community.

Mediation Effects of Social Cognition on the Relationship between Neurocognition and Social Functioning in Major Depressive Disorder and Schizophrenia Spectrum Disorders.

BACKGROUND: In schizophrenia spectrum disorders (SSD), social cognition mediates the relationship between neurocognition and social functioning. Although people with major depressive disorder (MDD) also exhibit cognitive impairments, which are often prolonged, little is known about the role of social cognition in MDD. METHODS: Using data obtained through an internet survey, 210 patients with SSD or MDD were selected using propensity score matching based on their demographics and illness duration. Social cognition, neurocognition, and social functioning were evaluated using the Self-Assessment of Social Cognition Impairments, Perceived Deficits Questionnaire, and Social Functioning Scale, respectively. The mediation effects of social cognition on the relationship between neurocognition and social functioning were examined in each group. Invariances of the mediation model across the two groups were then analyzed. RESULTS: The SSD and MDD groups had mean ages of 44.49 and 45.35 years, contained 42.0% and 42.8% women, and had mean illness durations of 10.76 and 10.45 years, respectively. In both groups, social cognition had significant mediation effects. Configural, measurement, and structural invariances across the groups were established. CONCLUSION: The role of social cognition in patients with MDD was similar to that in SSD. Social cognition could be a common endophenotype for various psychiatric disorders.

The Mental Health of Young Return Migrants with Ancestral Roots in Their Destination Country: A Cross-Sectional Study Focusing on the Ethnic Identities of Japanese-Brazilian High School Students Living in Japan.

BACKGROUND: The number of young Japanese Brazilians, who are return migrants with Japanese ancestral roots, is increasing rapidly in Japan. However, the characteristics of their mental health and the relation between mental health and a complex ethnic identity remains unclear. METHODS: This cross-sectional study compared 25 Japanese-Brazilian high school students with 62 Japanese high school students living in the same area. Research using self-report questionnaires on mental health, help-seeking behavior tendencies, and ethnic identity was conducted. The Japanese-Brazilian group was also divided into high and low ethnic identity groups, and their mental health conditions were compared. RESULTS: The Japanese-Brazilian group had significantly poorer mental health conditions and lower ethnic identities than the Japanese group and were less likely to seek help from family members and close relatives. Among the Japanese Brazilians, those with low ethnic identity had significantly poorer mental health than those with high ethnic identity. CONCLUSIONS: Young Japanese Brazilians may face conflicts of ethnic identity that can disturb their mental health. To build an inclusive society, the establishment of community services to support mental health and to help return migrants develop their ethnic identity is essential.

Relationship between Antenatal Mental Health and Facial Emotion Recognition Bias for Children's Faces among Pregnant Women.

The importance of identification of facial emotion recognition (FER) bias for a child's face has been reinforced from the perspective of risk screening for future peripartum mental health problems. We attempted to clarify the relationship of FER bias for children's faces with antenatal depression and bonding failure among pregnant women, taking into consideration their broad social cognitive abilities and experience in child raising. This study had a cross-sectional design, and participants were women in their second trimester of pregnancy. Seventy-two participants were assessed by the Edinburgh Postnatal Depression Scale (EPDS), the Mother-to-Infant Bonding Questionnaire (MIBQ), and a series of social cognitive tests. FER bias for a child's face was assessed by Baby Cue Cards (BCC), and a larger number of disengagement responses suggest greater sensitivity to a child's disengagement facial expressions. In a regression analysis conducted using EPDS as the dependent variable, a larger number of disengagement responses to the BCC (ß = 0.365, p = 0.001) and the primipara status (ß = -0.263, p = 0.016) were found to significantly contribute to antenatal depressive symptoms. Also, more disengagement responses to the BCC also significantly contributed to bonding failure as measured by the MIBQ (ß = 0.234, p = 0.048). Maternal sensitivity to the child's disengagement cues was associated with antenatal depressive symptoms and bonding failure more than the other social cognitive variables. The effects of FER bias on postpartum mental health and abusive behavior needs to be clarified by further longitudinal studies.

Effectiveness of a Comprehensive Mental Health Literacy Educational Programme for Junior High School Students: A Randomised Controlled Trial Examining Changes in Their Knowledge, Attitudes, and Behaviour.

BACKGROUND: This study evaluated the effectiveness of a comprehensive mental health literacy (MHL) educational programme known as "Sanita" for improving junior high school students' knowledge of mental illness, attitudes towards people with mental health problems, and help-seeking behaviour. METHODS: A randomised controlled trial with a parallel-group design was conducted. A total of 125 students (51 in the intervention group and 74 in the control group) received three 50-min classes and completed self-report questionnaires (Mental Illness and Disorder Understanding Scale, MIDUS; Reported and Intended Behaviour Scale, RIBS-J; and an original questionnaire investigating help-seeking behaviour) before and after the programme and three months later. RESULTS: Regarding MIDUS, the post-test and 3-month follow-up test results showed a significant main effect of time-by-group interactions in a linear mixed model. Regarding RIBS-J, the post-test results showed a significant main effect of time-by-group interactions; however, the 3-month follow-up test showed no significant effect. No significant effects of time-by-group interactions were seen in the post-test and 3-month follow-up test results for help-seeking behaviour in a logistic regression-mixed model. CONCLUSIONS: The Sanita MHL educational programme was longitudinally effective at improving junior high school students' knowledge of mental illness, although improvements in attitudes and help-seeking behaviour were insufficient.

Pharmacological interventions for social cognitive impairments in schizophrenia: A protocol for a systematic review and network meta-analysis.

Background: Social cognitive impairments adversely affect social functioning (e.g., employment status) in patients with schizophrenia. Although pharmacological interventions have been suggested to provide some benefits on social cognition, little information is available on the comparative efficacy of pharmacotherapy. Thus, the aim of this planned systematic review and network meta-analysis is to perform a quantitative comparison of the effects of various psychotropic drugs, including supplements, on social cognition disturbances of schizophrenia. Methods: The literature search will be carried out using the PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases from inception onward. Randomized controlled trials that examined the efficacy of drugs in social cognitive disturbances will be included, based on the most recent studies and the broader literature than previously searched. This protocol defines a priori the methods that will be used for study selection, data collection, quality assessment, and statistical syntheses. Discussion: The findings this work are expected to help promote the development of better therapeutics of social cognitive impairments in schizophrenia and related psychiatric conditions. Systematic Review Registration: [www.crd.york.ac.uk/prospero], identifier [CRD42021293224].

Perceptions of and subjective difficulties with social cognition in schizophrenia from an internet survey: Knowledge, clinical experiences, and awareness of association with social functioning.

AIM: Social cognition impacts social functioning in schizophrenia; however, little is known about how patients with schizophrenia themselves perceive social cognition. This study, using an internet survey, aimed to investigate their knowledge of social cognition, clinical experiences related to social cognition, awareness of social cognition's role in one's social life, and the relationships between subjective difficulties with social cognition and social functioning. METHODS: Data from 232 outpatients with schizophrenia (SZ) and 494 healthy controls (HC) were obtained through an internet survey and were weighted according to the demographics of the national population. A newly developed survey questionnaire on knowledge, experience, and awareness of social cognition was administered. Subjective difficulties were evaluated using the Self-Assessment of Social Cognition Impairments and the Observable Social Cognition Rating Scale. RESULTS: Less than a quarter of both groups were familiar with the term or concept of social cognition. Less than 5% of both groups had experienced being assessed or treated for social cognition. More than half of both groups were aware of the relationship between social cognition and social functioning. The SZ group had higher levels of subjective difficulties than the HC group across all social cognitive domains. The attributional bias domain of subjective difficulties was negatively associated with social functioning. CONCLUSION: Patients with schizophrenia had substantial subjective difficulties in social cognition, which they perceived as being related to social functioning. However, their knowledge of social cognition was limited, and the assessment and treatment might not be widespread in regular clinical practice.

Leakage of Endotoxins through the Endotoxin Retentive Filter: An in vitro Study.

INTRODUCTION: Ultrapurification of dialysis fluid has enabled highly efficient dialysis treatments. Online hemodiafiltration is one such treatment that uses a purified dialysis fluid as a supplemental fluid. In this method, an endotoxin retentive filter (ETRF) is used in the final step of dialysis fluid purification, with the aim of preventing leakage of endotoxins. Sodium hypochlorite and peracetic acid are used as disinfecting agents for the dialysis fluid pipes containing the ETRF; however, the effects of these agents on ETRF membrane pores have not been fully clarified. METHODS: Water permeability (flux) and endotoxin permeability were assessed in 3 types of ETRFs made with different membrane materials: polyester polymer alloy (PEPA), polyether sulfone (PES), and polysulfone (PS). High-concentration sodium hypochlorite and 2 types of peracetic acid were used as disinfecting agents, and the changes in flux and the endotoxin sieving coefficient (SC) were measured. RESULTS: After repeated use of high concentrations of sodium hypochlorite and peracetic acid, the PEPA and PES ETRFs did not permit passage of endotoxins, regardless of their flux. However, in the PS ETRF, the flux and endotoxin SC increased with the number of cleaning cycles. No differences were observed according to the concentration of peracetic acid disinfecting agents. CONCLUSION: PEPA and PES ETRFs completely prevent endotoxin leakage and can be disinfected at concentrations higher than the conventionally recommended concentration without affecting pore expansion. Even new PS ETRFs have low levels of endotoxin leakage, which increase after disinfection cycles using sodium hypochlorite and peracetic acid.

An integrated youth mental health service in a densely populated metropolitan area in Japan: Clinical case management bridges the gap between mental health and illness services.

AIMS: A global movement, including in Asia, is seeking to establish integrated youth mental health services that provide early intervention in the continuum from mental health to mental illness. Clinical case management (CCM), in which a case manager becomes not only a coordinator of services but also a provider of psychosocial support, can establish a 'one-stop network' that supports youth in densely populated areas with various social resources. In 2019, we opened a community-based centre called 'SODA' in front of a metropolitan railway station, which was designed to be highly accessible, stigma-free and youth-friendly to provide CCM. We aimed to clarify its services and effectiveness of CCM. METHODS: Data from 105 youths were investigated in a case-controlled study, dividing them into two groups: those who had received CCM for 6 months, and those whose needs were met in fewer sessions. RESULTS: Twenty-one subjects who received CCM for 6 months had difficulties in more domains than the others. The mean of the total service minutes for the subjects who received CCM for 6 months was 491.3 min: psychological support (accounted for 24.8% of the time), support for community living (31.2%), work support (13.8%), family support (10.5%) and support for cooperation with other organizations (19.8%). Global Assessment of Functioning (GAF) score improved significantly, from 46.6 at baseline to 59.3 at 6 months. CONCLUSION: Even in metropolitan areas with numerous medical facilities, young people can face high barriers to access. CCM can be effective as an early intervention for subjects developing mental illness.

Psychological impacts of the COVID-19 pandemic on one-month postpartum mothers in a metropolitan area of Japan.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has recently become the most important issue in the world. Very few reports in Japan have examined the impact of the COVID-19 pandemic on peripartum mental health. We examined the status of postpartum mental health before and during COVID-19 pandemic from a consecutive database in a metropolitan area of Japan. METHODS: The subjects were women who had completed a maternity health check-up at a core regional hospital in Yokohama during the period from April 1, 2017, to December 31, 2020. We collected the subjects' scores for the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale (MIBS) at 1 month postpartum. The subjects were divided into four groups (three Before COVID-19 groups and a During COVID-19 group). MANOVA and post-hoc tests were used to determine mental health changes in the postpartum period among the four groups. RESULTS: The Before and During COVID-19 groups contained 2844 and 1095 mothers, respectively. There were no significant difference in the total scores of the EPDS and MIBS among the four groups. However, the EPDS items related to anxiety factors were significantly higher and the EPDS items related to anhedonia and depression factors (excluding thoughts of self-harm) were significantly lower in the During COVID-19 group. CONCLUSION: The EPDS scores changed in connection with the COVID-19 pandemic. Anxiety, which represent hypervigilance, was significantly higher and anhedonia and depression were significantly lower in the During COVID-19 group. Our results may reflect COVID-19-related health concerns and a lack of social support caused by the COVID-19 pandemic.

The Effects of Hydrogen Annealing on Carbon Nanotube Field-Effect Transistors.

We have systematically investigated the effects of hydrogen annealing on Ni- and Al-contacted carbon nanotube field-effect transistors (CNTFETs), whose work functions have not been affected by hydrogen annealing. Measured results show that the electronic properties of single-walled carbon nanotubes are modified by hydrogen adsorption. The Ni-contacted CNTFETs, which initially showed metallic behavior, changed their p-FET behavior with a high on-current over 10 µA after hydrogen annealing. The on-current of the as-made p-FETs is much improved after hydrogen annealing. The Al-contacted CNTFETs, which initially showed metallic behavior, showed unipolar p-FET behavior after hydrogen annealing. We analyzed the energy band diagrams of the CNTFETs to explain experimental results, finding that the electron affinity and the bandgap of single-walled carbon nanotubes changed after hydrogen annealing. These results are consistent with previously reported ab initio calculations.

Study Protocol: The Evaluation Study for Social Cognition Measures in Japan (ESCoM).

In schizophrenia, social cognitive impairment is considered one of the greatest obstacles to social participation. Although numerous measures have been developed to assess social cognition, only a limited number of them have become available in Japan. We are therefore planning this evaluation study for social cognition measures in Japan (ESCoM) to confirm their psychometric characteristics and to promote research focused on social cognition. Participants in the cross-sectional observational study will be 140 patients with schizophrenia recruited from three Japanese facilities and 70 healthy individuals. In our primary analysis, we will calculate several psychometric indicators with a focus on whether they can independently predict social functioning. In secondary analyses, we will assess the reliability and validity of the Japanese translations of each measure and conduct an exploratory investigation of patient background, psychiatric symptoms, defeatist performance belief, and gut microbiota as determinants of social cognition. The protocol for this study is registered in UMIN-CTR, unique ID UMIN000043777.

Oriented Crystallization of Ammonium Sulfate from Hexagonal Boron Nitride/Sulfuric Acid Intercalation Compounds.

Controlling crystallization is a long-standing issue both from a fundamental and an applied perspective. In particular, our understanding of the influence of confinement on crystallization is far from complete. In this work, we utilize the confined interlayer spaces of hexagonal boron nitride (h-BN), which is one of the typical two-dimensional layered materials with atomically flat BN sheets, not only to prepare h-BN/H2SO4 intercalation compounds but also to initiate crystallization via the acid/base reaction between the intercalant (H2SO4) and gaseous ammonia. We report that the present acid/base reaction leads to the formation of highly oriented ammonium sulfate crystals along specific crystallographic directions. This oriented crystal growth originates from the 2D crystal nucleated in the confined interlayer spaces of h-BN.

Effects of motivation domains on social functioning in schizophrenia with consideration of the factor structure and confounding influences.

In patients with schizophrenia, motivation has been assumed to act as an intervening factor between cognitive function and social functioning. Motivation is thought to comprise three domains defined by their orientations: intrinsic motivation, extrinsic motivation, and amotivation. Although these orientations can confound each other, the effects of motivation domains on social functioning remain obscure. We investigated these relationships after confirming the factor structure of social functioning using the Social Functioning Scale (SFS). A total of 97 stable outpatients with schizophrenia were recruited. In addition to the SFS, the General Causality Orientations Scale (GCOS) was used to measure the motivation domains. First, we examined the factor structure of the SFS using exploratory and confirmatory factor analyses. Next, we conducted structural equation modeling to examine the effects of motivation domains on social functioning. The SFS showed a two-factor structure: interpersonal and intrapersonal functioning. The structural equation model revealed that (1) amotivation was negatively related to both intrapersonal and interpersonal functioning, (2) intrinsic motivation was positively related only to intrapersonal functioning, and (3) extrinsic motivation was positively related only to interpersonal functioning. Each motivation domain was associated with different factors of social functioning. Future interventions aimed at improving social functioning should consider these motivation domains based on their orientations. Cognitive remediation accompanied by considerations for and approaches to each of the domains may maximize recovery in patients with schizophrenia.

Impact of changes in social anxiety on social functioning and quality of life in outpatients with schizophrenia: A naturalistic longitudinal study.

The prevalence of comorbid social anxiety disorder among patients with schizophrenia is currently attracting attention, and symptoms of social anxiety are reportedly associated with various clinical features. However, the contribution of social anxiety to social functioning and quality of life (QOL) over time remains obscure. The aim of this study was to examine the impact of changes in social anxiety symptoms on social functioning and QOL among outpatients with schizophrenia. Of the 207 outpatients who were eligible at baseline, 118 patients agreed with and completed a follow-up investigation at least 1 year (695.8 days on average) after the baseline study. Stepwise multiple regressions examining the change in social functioning using demographic data and changes in clinical variables as explanatory variables demonstrated that the changes in social anxiety and general psychopathology contributed to the change in the Social Functioning Scale, while the changes in clinical severity and negative symptoms contributed to the change in the Global Assessment of Functioning scale. Stepwise multiple regressions for the change in QOL demonstrated that the changes in social anxiety and depression contributed to the change in the World Health Organization QOL scale, Brief version, and the changes in social anxiety and positive symptoms contributed to the Subjective Well-being Under Neuroleptic Drug Treatment, Short Form. The results revealed that the changes in social anxiety symptoms were significantly associated with the change in functional outcome among patients with schizophrenia. Treatments targeting social anxiety seem to be key to achieving a full recovery in patients with schizophrenia.

Associations Of Personality Traits With The Capacity-Performance Discrepancy Of Functional Outcome In Patients With Schizophrenia.

OBJECTIVE: Functional capacity, which indicates one's ability to perform everyday living tasks, contributes to real-world functional performance in patients with schizophrenia. However, functional capacity is sometimes not comparable with functional performance in clinical settings. We hypothesized that specific personality traits are related to this capacity-performance discrepancy of functional outcome. METHODS: The measures in this study were the UCSD Performance-based Skills Assessment Brief (UPSA-B) for functional capacity, the Social Functioning Scale (SFS) for functional performance, and the Temperament and Character Inventory-140 (TCI-140) for personality traits. A total of 94 stable outpatients with schizophrenia were divided into four groups based on combinations of their UPSA-B and SFS cut-off points, as follows: a high capacity and high performance (HH) group, a high capacity but low performance (HL) group, a low capacity but high performance (LH) group, and a low capacity and low performance (LL) group. RESULTS: There were no significant differences in demographics among the four groups. The LH group showed a significantly lower harm avoidance level than the LL group. The HL group showed a significantly lower persistence level than the HH group. CONCLUSION: Lower harm avoidance may enhance functional performance, and lower persistence can limit functional performance, regardless of the primary levels of functional capacity in patients with schizophrenia. Novel and individualized psychosocial treatments considering the individual's personality traits seem to be helpful for maximizing their functional performance in the community.