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Improving functional capacity, everyday life skills crucial for schizophrenia

Results from a network analysis showed that functional capacity and everyday life skills were the most central and highly interconnected variables in patients with schizophrenia, indicating that improving the ability to perform everyday tasks is critical to treating these patients.

“The Italian Network for Research on Psychoses has focused on the identification of variables influencing functioning, in particular, on the interplay among illness-related variables, personal resources, context-related variables and real-life functioning,” Silvana Galderisi, MD, department of psychiatry, Campania University, Italy, and colleagues wrote in JAMA Psychiatry. “However, modeling these associations and exploring their relative contribution to functioning by using structural equation models requires a priori assumptions concerning the associations among variables and the selection of predictors, mediators and outcomes.”

To better understand how psychopathologic variables, neurocognition, functional capacity, personal resources and functioning interact in schizophrenia, researchers assessed stable patients on antipsychotics recruited from 26 outpatient sites between Mar. 1, 2012, and Sept. 30, 2013 in a multicenter, cross sectional study. They conducted a network analysis using a data-driven approach among 740 community-dwelling patients with schizophrenia to measure psychopathologic variables, neurocognition, functional capacity, social cognition, real-life functioning, resilience, perceived stigma, incentives and service engagement.

Galderisi and colleagues found spatially contiguous patterns formed among resilience, neurocognition, social cognition and indices of real-life functioning, with densely interconnected nodes, among participants with schizophrenia; however, items regarding psychopathologic variables were not spatially contiguous. Results from the network analysis demonstrated that the most central and interconnected nodes were functional capacity and everyday life skills among participants with schizophrenia.

For psychopathologic variables, they found links between avolition and diminished expression, and also between the positive and disorganization dimensions, but not between negative and positive and disorganization symptoms. Analysis showed that he everyday life skills node was linked to disorganization and expressive deficits, indicating that functional capacity connected cognition with everyday life skills. Interpersonal relationships and work skills were both connected to avolition, whereas only the former was associated with social competence and only the latter was associated with work skills, social incentives and mental health services use.

“The high centrality of functional capacity and everyday life skills in the network is in line with the recovery-oriented approaches to schizophrenia, maintaining that the ability to perform tasks relevant to everyday life should represent the primary target of rehabilitation programs,” Galderisi and colleagues wrote. “Our findings strongly suggest that treatment beyond antipsychotic drugs is needed for people with schizophrenia, as positive symptoms are a peripheral node in the network. Therefore, targeting positive symptoms only, as treatment with antipsychotic medication does, is unlikely to lead to recovery in adults with schizophrenia.” – by Savannah Demko

Disclosures: Galderisi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.