Assessments targeting neurocognition, social cognition, positive symptoms, motivation, and access to resources may help to predict everyday functioning in patients with schizophrenia, suggests a study published in JAMA Psychiatry.
“Schizophrenia is no longer conceptualized as a progressive deteriorating illness,” wrote Armida Mucci, M.D., of the University of Campania Luigi Vanvitelli in Naples, Italy, and colleagues. “However, although a clinical stability with persistent symptomatic remission is now considered a realistic outcome for affected people, the level of social, vocational, and everyday life functioning attained by the majority of individuals with schizophrenia is still poor.”
Mucci and colleagues analyzed data from 618 clinically stable individuals with schizophrenia living in the community. They were recruited from 24 Italian university psychiatric clinics or mental health departments from March 2016 to December 2017. At both baseline and follow-up after four years, the participants were assessed for numerous illness-related factors (including negative symptoms, depression, neurocognition, social cognition, and psychiatric comorbidities), personal resources (including resilience and engagement with mental health services), context-related factors (including internalized stigma and available incentives such as access to family support or a disability pension), and real-life functioning. Each patient’s key caregiver was invited to join in the interview. The mean age at follow-up was 45 years.
Five baseline variables were directly associated with real-life functioning at follow-up, including the following:
- Higher neurocognitive abilities were associated with a positive change in everyday life skills, work skills, and interpersonal functioning.
- Higher baseline social cognition was associated with positive change in interpersonal functioning and work skills.
- Fewer problems with motivation were associated with positive change in interpersonal relationships.
- Positive symptoms were negatively but weakly associated with work skills.
- The greater the number of incentives available to participants was positively associated with everyday life skills.
Neurocognition, the authors noted, was by far the variable with the strongest association with functioning in everyday life at follow-up, “which is crucial for independent living and for reducing the burden on families and society.”
“People with schizophrenia, even in advanced stages of the disorder, require a detailed assessment of their psychopathological and functional characteristics,” Mucci and colleagues wrote. “If data relevant to the individual characteristics in all mentioned domains are available, then personalized and integrated management programs can be implemented, their impact can be constantly monitored, and changes to ongoing programs can be introduced to meet new or still unmet needs.”
For related information, see the Psychiatric News article “Milestones in the History of Schizophrenia. A Comprehensive Chronology of Schizophrenia Research: What Do We Know and When Did We Know It.”