Targeting Variables Increases Life-Function for Schizophrenia Patients

Armida Mucci, MD

While schizophrenia treatment has evolved from symptom reduction and relapse prevention to functional recovery in recent years, the recovery rates remain low.

However, identifying variables linked to the real-life functioning domains could help yield more effective personalized and integrated treatment programs.

A team, led by Armida Mucci, MD, Department of Psychiatry, University of Campania “Luigi Vanvitelli,” assessed whether baseline illness-related variables, personal resources, and context-related factors are linked to work skills, interpersonal relationships, and everyday life skills.

In the multicenter, prospective cohort trial, the investigators examined 618 patients with schizophrenia enrolled in a cross-sectional study across 24 Italian university psychiatric clinics or mental health departments. Each patient was contacted 4 years following their final assessment in the study. Of these patients, 427 were male with a mean age of 45.1 years old.

The investigators assessed psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors. The research team sought main outcomes of real-life functioning, using structural equation modeling, multiple regression analyses, and latent change score modeling to identify different variables associated with the main outcome at follow-up, as well as changes from baseline in these domains.

Baseline Variables

The researchers found 5 baseline variables directly associated with real-life functioning at follow-up—neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, −0.126; 95% CI, −0.190 to −0.062; P < .001); positive symptoms with work skills (β, −0.059; 95% CI, −0.112 to −0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001).

When the team implemented the multiple regression analysis, they found these variables accounted for the variability of functioning at follow-up after controlling for baseline functioning.

After using the latent change score model, the researchers found higher neurocognitive abilities were linked to with improvement of everyday life (β, 0.370; 95% CI, 0.253-0.486; P < .001) and work (β, 0.102; 95% CI, 0.016-0.188; P = .02) skills, social cognition (β, 0.133; 95% CI, 0.015-0.250; P = .03), and functional capacity (β, 1.138; 95% CI, 0.807-1.469; P < .001).

In addition, they found better baseline social cognition with improvement of work skills (β, 0.168; 95% CI, 0.075-0.261; P < .001) and interpersonal functioning (β, 0.140; 95% CI, 0.069-0.212; P < .001); and better baseline everyday life skills with improvement of work skills (β, 0.121; 95% CI, 0.077-0.166; P < .001).

Conclusion

“Findings of this large prospective study suggested that baseline variables associated with functional outcome at follow-up included domains not routinely assessed and targeted by intervention programs in community mental health services,” the authors wrote. “The key roles of social and nonsocial cognition and of baseline everyday life skills support the adoption in routine mental health care of cognitive training programs combined with personalized psychosocial interventions aimed to promote independent living.”

The study, “Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses,” was published online in JAMA Psychiatry.