2012 APA - IPS: Tools to Improve Functional Status in Patients with Schizophrenia

New validated assessment tools allow clinicians to better assess the level of real-life functioning in patients with schizophrenia.

New York, NY —A pilot study conducted by the National Council for Community Behavioral Healthcare to improve the day-to-day functioning of people with schizophrenia was presented at the American Psychiatric Association Institute on Psychiatric Services.

Interventions for schizophrenia have typically placed an emphasis on the treatment of symptoms. In this six-month behavioral intervention program, the objective was to increase the level of real-life functioning in patients with the use of a nationally accepted behavioral intervention program and to implement a reliable tool to measure the results.

Upon completion, the study demonstrated significant improvement in daily living activities and functioning among this patient population. Researchers anticipate that the study’s positive outcomes will encourage clinicians to use the same validated assessment tools to easily quantify patient functioning and identify areas in need of improvement.

A total of 568 outpatients with schizophrenia with an average age of 45.7 years were recruited in 10 behavioral health centers across the United States. Study intervention consisted of meeting with a clinician on a monthly basis and training in a Wellness Self-Management (WSM) curriculum; a personal workbook that focused on topics geared toward recovery such as information about mental illness and treatment; goal setting; and developing a relapse prevention plan. The curriculum is based on an evidence-based practice known as Illness Management and Recovery (IMR) for adults with serious mental illness.

Functional status was assessed at baseline and at 2, 4, and 6 months using Daily Living Activities-20 (DLA-20), a validated, clinician-administered, 20-item outcome measure that assesses limitations in communication, coping skills, physical and mental health care practices, and problem solving with a score of 20-140. The Modified Global Assessment of Functioning (mGAf) is estimated by dividing the total score of the DLA in half, yielding scores of 10 to 70. In both scales, high scores indicate greater functioning. A score of < 38 on the mGAF indicates impairment in at least five areas of daily living.

At baseline, 20% of patients scored below 38 on the mGAF. An analysis of the DLA-20 at each of the four time points during the intervention demonstrated increasing gains with each assessment, with a mean DLA-20 change from baseline of 1.8 (at 2 months), 3.9 (at 3 months), and 6.4 (at 4 months). Patients who reported improvements at 6 months (n=197) showed an 18.4% improvement in DLA-20 score. Among patients who showed an improvement in DLA-20, the mGAF score increased by 18.4%. The DLA-20 items with the most improvement were housing stability, communication, leisure, social network, and coping.

Study author Mohini Venkatesh, MPH, Senior Director of Public Policy at the NCCM, expanded on the findings. “At the end of the study we saw an improvement in several areas. There was improvement in terms of therapeutic alliance, which is important for this population to maintain an ongoing provider relationship that allows the opportunity to address a variety of health issues. Communication improved in terms of patients talking about their concerns. Coping skills improved to the extent that patients were able to articulate what they were feeling when stressed and implement skills they learned from WSM,” she said.

The abstract of this poster is available here.