Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138, Naples, Italy.
World Psychiatry. 2014 Oct;13(3):275-87. doi: 10.1002/wps.20167.
In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real-life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness-related variables, personal resources and context-related factors. Some of these variables were never investigated before in relationship with real-life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real-life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real-life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real-life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real-life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia.
在患有精神分裂症的人群中，日常生活的主要方面都受到损害，包括独立生活、生产活动和社会关系。增强对阻碍现实生活功能的因素的理解，对于将治疗转化为更积极的结果至关重要。本研究的目的是确定精神分裂症患者现实生活功能的预测因素，并评估它们的相对贡献。基于以前的文献和临床经验，选择了几个因素，并将其分为三类：与疾病相关的变量、个人资源和与环境相关的因素。其中一些变量以前从未在与现实生活功能的关系中进行过调查。在 921 名居住在社区中的精神分裂症患者中，我们发现，与疾病相关的变量、个人资源和社会环境在结构方程模型中解释了现实生活功能变异性的 53.8%。神经认知与现实生活功能的关系最强，尽管是间接的。阳性症状和混乱，以及意志减退，被证明具有显著的直接和间接影响，而抑郁没有显著的关联，情绪表达差只是间接地、微弱地与现实生活功能相关。残疾抚恤金的发放和获得社会和家庭激励也与功能有显著的直接关联。社会认知、功能能力、适应力、内化的耻辱感和参与心理健康服务是中介。所观察到的调查预测因素、中介因素和现实生活功能之间的复杂关联强烈表明，应该为精神分裂症患者提供综合和个性化的方案作为标准治疗。
