P Rocca1, S Galderisi2, A Rossi3, A Bertolino4, P Rucci5, D Gibertoni5, C Montemagni6, S Bellino6, E Aguglia7, M Amore8, A Bellomo9, M Biondi10, B Carpiniello11, A Cuomo12, E D'Ambrosio4, L dell'Osso13, P Girardi14, C Marchesi15, P Monteleone16, C Montemitro17, L Oldani18, F Pacitti3, R Roncone19, A Siracusano20, E Tenconi21, A Vita22, P Zeppegno23, L Steardo2, A Vignapiano2, M Maj2. 1. Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy. Electronic address: paola.rocca@unito.it. 2. Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy. 3. Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy. 4. Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy. 5. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. 6. Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy. 7. Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy. 8. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy. 9. Department of Medical Sciences, Psychiatry Unit, University of Foggia, Foggia, Italy. 10. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy. 11. Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry, University of Cagliari, Cagliari, Italy. 12. Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy. 13. Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy. 14. Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy. 15. Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy. 16. Department of Medicine and Surgery, Chair of Psychiatry, University of Salerno, Salerno, Italy. 17. Department of Neuroscience and Imaging, Chair of Psychiatry, G. d'Annunzio University, Chieti, Italy. 18. Department of Psychiatry, University of Milan, Milan, Italy. 19. Department of Life, Health and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy. 20. Department of Systems Medicine, Chair of Psychiatry, Tor Vergata University of Rome, Rome, Italy. 21. Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy. 22. Psychiatric Unit, School of Medicine, University of Brescia, and Department of Mental Health, Spedali Civili Hospital, Brescia, Italy. 23. Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy.
Abstract
BACKGROUND: A general consensus has not yet been reached regarding the role of disorganization symptoms in real-world functioning in schizophrenia. METHODS: We used structural equations modeling (SEM) to analyze the direct and indirect associations between disorganization and real-world functioning assessed through the Specific Levels of Functioning Scale (SLOF) in 880 subjects with schizophrenia. RESULTS: We found that: 1) conceptual disorganization was directly and strongly connected with SLOF daily activities; difficulty in abstract thinking was associated with moderate strength to all SLOF domains, and poor attention was connected with SLOF work skills; 2) grandiosity was only related with poor work skills, and delusions were associated with poor functioning in all SLOF domains; interpersonal relationships were weakly indirectly influenced by hallucinatory behavior, delusions and unusual thought contents through the mediation of social cognition (SC); 3) among the negative symptoms, avolition had only direct links with SLOF work skills and SLOF activities; anhedonia had direct links with SLOF work skills and SLOF interpersonal and indirect link with SLOF work skills through functional capacity (FC); asociality with SLOF interpersonal; blunted affect had direct links with SLOF activities and indirect links with SLOF interpersonal relationships mediated by SC. Lastly, alogia had only indirect links mediated by SC, FC, and neurocognition (NC). CONCLUSIONS: Overall conceptual disorganization is the symptom that contributed more (both directly and indirectly) to the activities of community living in real-world. Thus, it should be considered as a treatment target in intervention programs for patients with schizophrenia.
BACKGROUND: A general consensus has not yet been reached regarding the role of disorganization symptoms in real-world functioning in schizophrenia. METHODS: We used structural equations modeling (SEM) to analyze the direct and indirect associations between disorganization and real-world functioning assessed through the Specific Levels of Functioning Scale (SLOF) in 880 subjects with schizophrenia. RESULTS: We found that: 1) conceptual disorganization was directly and strongly connected with SLOF daily activities; difficulty in abstract thinking was associated with moderate strength to all SLOF domains, and poor attention was connected with SLOF work skills; 2) grandiosity was only related with poor work skills, and delusions were associated with poor functioning in all SLOF domains; interpersonal relationships were weakly indirectly influenced by hallucinatory behavior, delusions and unusual thought contents through the mediation of social cognition (SC); 3) among the negative symptoms, avolition had only direct links with SLOF work skills and SLOF activities; anhedonia had direct links with SLOF work skills and SLOF interpersonal and indirect link with SLOF work skills through functional capacity (FC); asociality with SLOF interpersonal; blunted affect had direct links with SLOF activities and indirect links with SLOF interpersonal relationships mediated by SC. Lastly, alogia had only indirect links mediated by SC, FC, and neurocognition (NC). CONCLUSIONS: Overall conceptual disorganization is the symptom that contributed more (both directly and indirectly) to the activities of community living in real-world. Thus, it should be considered as a treatment target in intervention programs for patients with schizophrenia.
Keywords:
Conceptual disorganization; Functional capacity; Italian Network for Research on Psychoses (NIRP); Real-world functioning; Schizophrenia; Social cognition
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