Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study.

BACKGROUND

Recovery has become a priority in schizophrenia spectrum disorders (SSDs). This study aimed to investigate predictors of objective-general functioning and disability-and subjective-quality of life (QoL)-measures of functional outcomes in SSD.

METHODS

Sample: = 77 SSD outpatients (age 18-64, IQ > 70) participating in a randomised controlled trial. Baseline data were used to build three multivariable linear regression models on: (i) general functioning-General Assessment of Functioning (GAF); (ii) disability-the World Health Organization Disability Assessment Schedule (WHODAS-2.0); and (iii) QoL-Satisfaction Life Domains Scale (SLDS).

RESULTS

Young age and being employed (R change = 0.211; = 0.001), late adolescence premorbid adjustment (R change = 0.049; = 0.0050), negative symptoms and disorganization (R change = 0.087; = 0.025) and Theory of Mind (R change = 0.066, = 0.053) predicted general functioning. Previous suicidal behaviour (R change = 0.068; = 0.023) and negative and depressive symptoms (R change = 0.167; = 0.001) were linked with disability. Previous suicidal behaviour (R change = 0.070, = 0.026), depressive symptoms (R change = 0.157; < 0.001) and illness recognition (R change = 0.046, = 0.044) predicted QoL.

CONCLUSIONS

Negative, disorganization and depressive symptoms, older age, unemployment, poor premorbid adjustment, previous suicide attempts and illness awareness appear to underlie a poor global functional outcome in SSD. Achieving recovery in SSD appears to require both symptomatic remission (e.g., through antipsychotics) and measures to improve mastery and relieve low mood.