Department of Psychiatry, Campania University "Luigi Vanvitelli," Naples, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
JAMA Psychiatry. 2018 Apr 1;75(4):396-404. doi: 10.1001/jamapsychiatry.2017.4607.
Enhanced understanding of factors associated with symptomatic and functional recovery is instrumental to designing personalized treatment plans for people with schizophrenia. To date, this is the first study using network analysis to investigate the associations among cognitive, psychopathologic, and psychosocial variables in a large sample of community-dwelling individuals with schizophrenia.
To assess the interplay among psychopathologic variables, cognitive dysfunctions, functional capacity, personal resources, perceived stigma, and real-life functioning in individuals with schizophrenia, using a data-driven approach.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter, cross-sectional study involved 26 university psychiatric clinics and/or mental health departments. A total of 921 community-dwelling individuals with a DSM-IV diagnosis of schizophrenia who were stabilized on antipsychotic treatment were recruited from those consecutively presenting to the outpatient units of the sites between March 1, 2012, and September 30, 2013. Statistical analysis was conducted between July 1 and September 30, 2017.
Measures covered psychopathologic variables, neurocognition, social cognition, functional capacity, real-life functioning, resilience, perceived stigma, incentives, and service engagement.
Of 740 patients (221 women and 519 men; mean [SD] age, 40.0 [10.9] years) with complete data on the 27 study measures, 163 (22.0%) were remitted (with a score of mild or better on 8 core symptoms). The network analysis showed that functional capacity and everyday life skills were the most central and highly interconnected nodes in the network. Psychopathologic variables split in 2 domains, with positive symptoms being one of the most peripheral and least connected nodes. Functional capacity bridged cognition with everyday life skills; the everyday life skills node was connected to disorganization and expressive deficits. Interpersonal relationships and work skills were connected to avolition; the interpersonal relationships node was also linked to social competence, and the work skills node was linked to social incentives and engagement with mental health services. A case-dropping bootstrap procedure showed centrality indices correlations of 0.75 or greater between the original and randomly defined samples up to 481 of 740 case-dropping (65.0%). No difference in the network structure was found between men and women.
The high centrality of functional capacity and everyday life skills in the network suggests that improving the ability to perform tasks relevant to everyday life is critical for any therapeutic intervention in schizophrenia. The pattern of network node connections supports the implementation of personalized interventions.
增强对与症状和功能恢复相关因素的理解，对于为精神分裂症患者制定个性化治疗计划至关重要。迄今为止，这是第一项使用网络分析研究认知、精神病理和心理社会变量在大量社区居住的精神分裂症患者中的关联的研究。
使用数据驱动的方法评估精神病理变量、认知功能障碍、功能能力、个人资源、感知耻辱感和现实生活功能在精神分裂症个体中的相互作用。
设计、地点和参与者：这是一项多中心、横断面研究，涉及 26 个大学精神病学诊所和/或心理健康部门。共有 921 名符合 DSM-IV 精神分裂症诊断标准、接受抗精神病药物治疗稳定的社区居民从 2012 年 3 月 1 日至 2013 年 9 月 30 日期间连续在各地点的门诊单位就诊。统计分析于 2017 年 7 月 1 日至 9 月 30 日进行。
测量包括精神病理变量、神经认知、社会认知、功能能力、现实生活功能、适应力、感知耻辱感、激励措施和服务参与度。
在 740 名患者（221 名女性和 519 名男性；平均[SD]年龄 40.0[10.9]岁）中，有 27 项研究措施中有 163 名（8 项核心症状的评分均为轻度或更轻）有完整数据。网络分析显示，功能能力和日常生活技能是网络中最中心和高度相互关联的节点。精神病理变量分为 2 个领域，阳性症状是最外围和连接最少的节点之一。功能能力连接认知与日常生活技能；日常生活技能节点与混乱和表达缺陷有关。人际关系和工作技能与意志减退有关；人际关系节点还与社会能力有关，工作技能节点与社会激励和与精神卫生服务的参与有关。病例剔除引导程序显示，在病例剔除 481 例（65.0%）之前，原始和随机定义样本之间的中心性指数相关性为 0.75 或更高。男性和女性之间的网络结构没有差异。
功能能力和日常生活技能在网络中的高中心性表明，提高与日常生活相关任务的能力对于精神分裂症的任何治疗干预都至关重要。网络节点连接的模式支持个性化干预措施的实施。
