Identification of common problems of functioning in schizophrenia and the environmental factors that contribute to them offers a comprehensive approach to assessing patients with schizophrenia and helps inform interventions that could facilitate improved functioning, according to a study published in Psychiatry Research.

For this cross-sectional multicenter study, 127 patients diagnosed with schizophrenia spectrum disorder were recruited from 5 centers in Spain. Using the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework, 133 categories were used to classify clinical and sociodemographic information and the impact of personal and environmental factors on the functioning of patients with schizophrenia. A total of 69 categories corresponding to the Body functions _ICF component and 45 categories corresponding to the Activities and participation_ICF component were used to evaluate the degree of disability in study participants. The remaining 19 categories corresponding to the Environmental factors component were designated as facilitators (positive response) or barriers (negative response).

Among Body functions categories, more than 50% of the participants showed impaired cognitive function, a problem consistent with primary manifestations of schizophrenia. Over 50% of the participants also showed functional impairment in Activities and participation categories including problem-solving, handling stress, self-care, domestic life social relationships, employment, and leisure. More than half of the study participants who achieved clinical remission still had challenges in everyday activities, suggesting that functional remission does not always accompany clinical remission. A composite analysis of the study data indicated that patients who practiced better self-care were more involved in work, education, or leisure activities and demonstrated better overall health.

Although 29% of patients reported all Environmental factors as facilitators, study results indicated that the most common categories perceived as being facilitating, included support from both family and health professionals, antipsychotic medications, and social and health services. All of these categories received positive responses in at least 85% of the study sample participants. The most common barriers identified were in the categories of societal attitudes as well as products or substances of personal consumption, an issue related to substance abuse and dependence, issues associated with pharmacologic therapies, or medication nonadherence.

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The extended ICF checklist for schizophrenia used in this study provided a clinical approach for the identification of the most common problems with functioning and environmental factors that facilitate improvement. The study investigators suggest that the ICF is valuable for describing functioning in patients with schizophrenia and could be used in the design of effective interventions and disease management.


Barrios M, Gómez-Benito J, Pino O, Rojo E, Guilera G. Functioning in patients with schizophrenia: A multicenter study evaluating the clinical perspective [published online June 3, 2018]. Psychiatry Res. doi: 10.1016/j.psychres.2018.05.079