Fernand-Seguin Research Centre, Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Community Ment Health J. 2013 Jun;49(3):317-22. doi: 10.1007/s10597-012-9525-y. Epub 2012 Jul 31.
Community functioning is a broad term that encompasses various 'real world' measures of disability among schizophrenia patients. It includes outcomes such as independent living, social competence and behavioural problems-all of which are priorities for treatment among schizophrenia patients, mental health care providers, and family members. An important goal for rehabilitation programs is to identify predictors of community functioning which, in turn, could be used as targets for intervention. The present case-control study examined socio-demographic and substance use disorder (SUD) variables as well as psychiatric, extrapyramidal, and cognitive symptoms as predictors of community functioning in schizophrenia patients with (DD patients; n=31) and without comorbid SUDs (SCZ patients; n=31), and non-psychosis substance abusers (SUD patients; n=39). Psychiatric and extrapyramidal symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia and the Extrapyramidal Symptoms Rating Scale. Cognition was evaluated using the Cambridge Neuropsychological Test Automated Battery (speed of processing, explicit and working memory). In SCZ patients, community functioning was predicted by explicit memory performance. In DD patients, community functioning was predicted by substance abuse, depression and speed of processing. In SUD patients, community functioning was predicted by substance abuse, positive symptoms and education. Our results suggest that cognition should be among the top treatment priorities in SCZ patients, whereas the key treatment targets in DD patients should be substance abuse and depression. Future studies will need to replicate the current findings, using prospective research designs.
社区功能是一个广泛的术语，涵盖了精神分裂症患者各种“现实世界”的残疾衡量标准。它包括独立生活、社交能力和行为问题等结果，所有这些都是精神分裂症患者、精神健康护理提供者和家庭成员治疗的优先事项。康复计划的一个重要目标是确定社区功能的预测因素，这些因素反过来又可以作为干预的目标。本病例对照研究检查了社会人口统计学和物质使用障碍（SUD）变量以及精神病、锥体外系和认知症状，作为伴有（DD 患者；n=31）和不伴有共病 SUDs（SCZ 患者；n=31）的精神分裂症患者以及非精神病物质滥用者（SUD 患者；n=39）社区功能的预测因素。精神病和锥体外系症状采用阳性和阴性综合征量表、卡尔加里精神分裂症抑郁量表和锥体外系症状评定量表进行评估。认知使用剑桥神经心理学测试自动化电池（处理速度、显性和工作记忆）进行评估。在 SCZ 患者中，显性记忆表现预测了社区功能。在 DD 患者中，物质滥用、抑郁和处理速度预测了社区功能。在 SUD 患者中，物质滥用、阳性症状和教育预测了社区功能。我们的研究结果表明，认知应该是 SCZ 患者的首要治疗重点之一，而 DD 患者的关键治疗目标应该是物质滥用和抑郁。未来的研究需要使用前瞻性研究设计来复制当前的发现。
