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07-10-2014 | Mental health | Article

Complex associations underlie functional variance in schizophrenia


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medwireNews: The complex associations between predictors and mediators of real-life functioning highlight the need for integrated and personalised treatment for patients with schizophrenia, say researchers in World Psychiatry.

The team’s research produced a model containing five predictors: positive symptoms, disorganised symptoms, avolition, neurocognition and incentives, such as support from the family and receipt of a disability pension.

Neurocognition had the largest overall effect on patients’ functioning, which “suggests that training addressing neurocognitive and social cognition impairment should be part of integrated treatment packages for schizophrenia”, say Silvana Galderisi (University of Naples SUN, Italy) and co-workers.

However, the effects of neurocognition were entirely indirect, being exerted through a negative effect on the five mediators identified in the model: engagement with services, functional capacity, social cognition and resilience via internalised stigma.

The complexity of this pathway “suggests that, in order to enhance the impact of interventions targeting neurocognitive impairment on functioning in the real life, we also need to promote reduction of internalized stigma related to mental illness and minimize its negative effects”, says the team.

Of the mediators identified, only internalised stigma had no direct effect on functioning, exerting all its influence via resilience.

The study included 921 schizophrenia patients (641 men; 280 women), nearly all of whom were taking an antipsychotic, with a quarter also receiving psychosocial interventions. Their real-life functioning, assessed on the Specific Level of Functioning Scale, was modestly reduced overall, with some domains, such as interpersonal relationships and working abilities, moderately affected.

The five independent predictors and five mediators in the model together explained 53.8% of the variance in patients’ functioning. With the exception of neurocognition, all the predictors had direct effects on functioning, with all except incentives also having indirect effects.

The strongest predictors of functioning besides neurocognition were disorganisation symptoms and avolition, followed by functional capacity, service engagement, social cognition, positive symptoms, incentives, resilience and internalised stigma.

The study authors highlight the strong effect of avolition, which affected functioning directly, and also indirectly through service engagement and resilience (both directly and via internalised stigma).

“Efforts aimed to improve our understanding of the pathophysiology of avolition represent a priority of research in schizophrenia, and the implementation of treatments targeting motivation is likely to be an important tool to enable people with schizophrenia to achieve a meaningful life”, they say.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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