Patterson T L, Klapow J C, Eastham J H, Heaton R K, Evans J D, Koch W L, Jeste D V
Department of Psychiatry, University of California, San Diego Geriatric Psychiatry Clinical Research Center, Veterans Affairs Medical Center 92093-0680, USA.
Psychiatry Res. 1998 Jul 27;80(1):41-52. doi: 10.1016/s0165-1781(98)00060-2.
There is a growing recognition of the importance of quantifying the impact of illness on functional abilities. Measures of function frequently rely on a self-report. Few studies have directly assessed functional capacity in psychiatric patients, especially older ones who may be at an increased risk for disability. Subjects were 102 middle-aged and elderly outpatients with DSM-III-R or DSM-IV diagnosis of schizophrenia or schizoaffective disorder, and 66 normal comparison subjects, ranging in age from 45 to 86. The Direct Assessment of Functional Status (DAFS), a standardized measure of behavior during simulated daily activity tasks (i.e. time orientation, communication, transportation, finance, shopping, grooming and eating) was used to quantify levels of disability. Schizophrenic patients demonstrated significantly greater disability than normal subjects. An evaluation of specific behaviors indicated that the patients were significantly more limited than comparison subjects across all subscales of the DAFS except for grooming and eating. A lower level of formal education, greater severity of extrapyramidal symptoms, and greater cognitive deficits, but not severity of symptoms of schizophrenia, were related to lower DAFS scores. Relative to published findings, schizophrenic patients appeared more disabled than outpatients with major depression, but less disabled than those with Alzheimer's disease. The DAFS is a useful instrument for characterizing functional abilities in older patients with schizophrenia. Our findings of significant functional disability in older schizophrenic patients have implications for treatment as well as allocation of health-care resources.
人们越来越认识到量化疾病对功能能力影响的重要性。功能测量常常依赖自我报告。很少有研究直接评估精神疾病患者的功能能力，尤其是那些可能面临更高残疾风险的老年患者。研究对象包括102名患有精神分裂症或分裂情感性障碍且符合DSM-III-R或DSM-IV诊断标准的中老年门诊患者，以及66名年龄在45至86岁之间的正常对照者。采用功能状态直接评估法（DAFS），这是一种对模拟日常活动任务（即时间定向、沟通、交通、财务、购物、修饰和进食）中的行为进行标准化测量的方法，以量化残疾水平。精神分裂症患者的残疾程度明显高于正常受试者。对特定行为的评估表明，除修饰和进食外，患者在DAFS的所有子量表上的受限程度均显著高于对照者。较低的正规教育水平、锥体外系症状的更严重程度以及更大的认知缺陷，但不是精神分裂症症状的严重程度，与较低的DAFS分数相关。相对于已发表的研究结果，精神分裂症患者似乎比重度抑郁症门诊患者残疾程度更高，但比阿尔茨海默病患者残疾程度更低。DAFS是一种用于描述老年精神分裂症患者功能能力的有用工具。我们关于老年精神分裂症患者存在显著功能残疾的研究结果对治疗以及医疗资源的分配具有重要意义。
