Improving the ability to perform tasks relevant to everyday life is critical for any therapeutic intervention in individuals with schizophrenia, according to the results of a multicenter cross-sectional network analysis study involving 26 university psychiatric clinics and/or mental health departments published in JAMA Psychiatry.
Silvana Galderisi, MD, of the Department of Psychiatry at Campania University Luigi Vanvitelli in Naples, Italy, and colleagues recruited 921 consecutive community-dwelling individuals with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnosis of schizophrenia who were stabilized on antipsychotic therapy and presented to outpatient units between March 1, 2012 and September 30, 2013. Measures included psychopathologic variables, neurocognition, social cognition, functional capacity, real-life functioning, resilience, perceived stigma, and service engagement.
Of 740 patients with complete data on the 27 study measures, 163 (22.0%) achieved remission with a score of mild or better on 8 core symptoms. Network analysis showed that functional capacity and everyday life skills were the most central and highly interconnected nodes in the network, while positive psychopathologic symptoms were one of the most peripheral and least connected nodes. Functional capacity connected cognition with everyday life skills, while the everyday life skills node was linked to disorganization and expressive deficits.
The investigators noted that functional capacity is the node that links neurocognition and social cognition with real-life functioning nodes, particularly everyday skills such as household activities, handling of personal finances, use of the telephone, and public transportation. They suggested that these findings support the choice of functional capacity as a meaningful co-primary measure in clinical trials of cognition enhancement in schizophrenia.
They further argued that treatment beyond antipsychotic drugs is needed in people with schizophrenia, as positive symptoms are a peripheral node in the network, and thus targeting positive symptoms only as antipsychotic medication does not likely to lead to recovery. They also suggested that “[t]he network analysis might contribute to a shift from simpler, a priori models of established causal associations between variables to the recognition of the complex interdependence between disease-related factors, personal resources, environmental variables, and real-life functioning.”
Galderisi S, Rucci P, Kirkpatrick B, et al. Interplay among psychopathologic variables, personal resources, context-related factors, and real-life functioning in individuals with schizophrenia: a network analysis [published online February 14, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4607.