Armida Mucci1, Silvana Galderisi1, Dino Gibertoni2, Alessandro Rossi3, Paola Rocca4, Alessandro Bertolino5, Eugenio Aguglia6, Mario Amore7, Antonello Bellomo8, Massimo Biondi9, Giuseppe Blasi5, Claudio Brasso4, Paola Bucci1, Bernardo Carpiniello10, Alessandro Cuomo11, Liliana Dell'Osso12, Giulia Maria Giordano1, Carlo Marchesi13, Palmiero Monteleone14, Cinzia Niolu15, Lucio Oldani16, Mauro Pettorruso17, Maurizio Pompili18, Rita Roncone19, Rodolfo Rossi3, Elena Tenconi20, Antonio Vita21,22, Patrizia Zeppegno23, Mario Maj1. 1. Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy. 2. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. 3. Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy. 4. Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy. 5. Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy. 6. Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy. 7. Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy. 8. Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy. 9. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy. 10. Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy. 11. Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy. 12. Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 13. Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy. 14. Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," Section of Neuroscience, University of Salerno, Salerno, Italy. 15. Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy. 16. Department of Psychiatry, State University of Milan, Milan, Italy. 17. Department of Neuroscience and Imaging, G. D'Annunzio University, Chieti, Italy. 18. Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy. 19. Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. 20. Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy. 21. Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy. 22. Department of Mental Health, Spedali Civili Hospital, Brescia, Italy. 23. Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy.
Abstract
Importance: The goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs. Objective: To assess whether baseline illness-related variables, personal resources, and context-related factors are associated with work skills, interpersonal relationships, and everyday life skills at 4-year follow-up. Design, Setting, and Participants: This multicenter prospective cohort study was conducted across 24 Italian university psychiatric clinics or mental health departments in which 921 patients enrolled in a cross-sectional study were contacted after 4 years for reassessment. Recruitment of community-dwelling, clinically stable persons with schizophrenia was conducted from March 2016 to December 2017, and data were analyzed from January to May 2020. Main Outcomes and Measures: Psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors were assessed, with real-life functioning as the main outcome. Structural equation modeling, multiple regression analyses, and latent change score modeling were used to identify variables that were associated with real-life functioning domains at follow-up and with changes from baseline in these domains. Results: In total, 618 participants (427 male [69.1%]; mean [SD] age, 45.1 [10.5] years) were included. Five baseline variables were directly associated with real-life functioning at follow-up: neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, -0.126; 95% CI, -0.190 to -0.062; P < .001); positive symptoms with work skills (β, -0.059; 95% CI, -0.112 to -0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001). Multiple regression analyses indicated that these variables accounted for the variability of functioning at follow-up after controlling for baseline functioning. In the latent change score model, higher neurocognitive abilities were associated with improvement of everyday life (β, 0.370; 95% CI, 0.253-0.486; P < .001) and work (β, 0.102; 95% CI, 0.016-0.188; P = .02) skills, social cognition (β, 0.133; 95% CI, 0.015-0.250; P = .03), and functional capacity (β, 1.138; 95% CI, 0.807-1.469; P < .001); better baseline social cognition with improvement of work skills (β, 0.168; 95% CI, 0.075-0.261; P < .001) and interpersonal functioning (β, 0.140; 95% CI, 0.069-0.212; P < .001); and better baseline everyday life skills with improvement of work skills (β, 0.121; 95% CI, 0.077-0.166; P < .001). Conclusions and Relevance: Findings of this large prospective study suggested that baseline variables associated with functional outcome at follow-up included domains not routinely assessed and targeted by intervention programs in community mental health services. The key roles of social and nonsocial cognition and of baseline everyday life skills support the adoption in routine mental health care of cognitive training programs combined with personalized psychosocial interventions aimed to promote independent living.
Importance: The goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs. Objective: To assess whether baseline illness-related variables, personal resources, and context-related factors are associated with work skills, interpersonal relationships, and everyday life skills at 4-year follow-up. Design, Setting, and Participants: This multicenter prospective cohort study was conducted across 24 Italian university psychiatric clinics or mental health departments in which 921 patients enrolled in a cross-sectional study were contacted after 4 years for reassessment. Recruitment of community-dwelling, clinically stable persons with schizophrenia was conducted from March 2016 to December 2017, and data were analyzed from January to May 2020. Main Outcomes and Measures: Psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors were assessed, with real-life functioning as the main outcome. Structural equation modeling, multiple regression analyses, and latent change score modeling were used to identify variables that were associated with real-life functioning domains at follow-up and with changes from baseline in these domains. Results: In total, 618 participants (427 male [69.1%]; mean [SD] age, 45.1 [10.5] years) were included. Five baseline variables were directly associated with real-life functioning at follow-up: neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, -0.126; 95% CI, -0.190 to -0.062; P < .001); positive symptoms with work skills (β, -0.059; 95% CI, -0.112 to -0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001). Multiple regression analyses indicated that these variables accounted for the variability of functioning at follow-up after controlling for baseline functioning. In the latent change score model, higher neurocognitive abilities were associated with improvement of everyday life (β, 0.370; 95% CI, 0.253-0.486; P < .001) and work (β, 0.102; 95% CI, 0.016-0.188; P = .02) skills, social cognition (β, 0.133; 95% CI, 0.015-0.250; P = .03), and functional capacity (β, 1.138; 95% CI, 0.807-1.469; P < .001); better baseline social cognition with improvement of work skills (β, 0.168; 95% CI, 0.075-0.261; P < .001) and interpersonal functioning (β, 0.140; 95% CI, 0.069-0.212; P < .001); and better baseline everyday life skills with improvement of work skills (β, 0.121; 95% CI, 0.077-0.166; P < .001). Conclusions and Relevance: Findings of this large prospective study suggested that baseline variables associated with functional outcome at follow-up included domains not routinely assessed and targeted by intervention programs in community mental health services. The key roles of social and nonsocial cognition and of baseline everyday life skills support the adoption in routine mental health care of cognitive training programs combined with personalized psychosocial interventions aimed to promote independent living.
Authors: Wei Yu; Jie Tong; Xirong Sun; Fazhan Chen; Jie Zhang; Yu Pei; Tingting Zhang; Jiechun Zhang; Binggen Zhu Journal: Int J Environ Res Public Health Date: 2021-04-29 Impact factor: 3.390
Authors: Giulia M Giordano; Francesco Brando; Andrea Perrottelli; Giorgio Di Lorenzo; Alberto Siracusano; Luigi Giuliani; Pasquale Pezzella; Mario Altamura; Antonello Bellomo; Giammarco Cascino; Antonio Del Casale; Palmiero Monteleone; Maurizio Pompili; Silvana Galderisi; Mario Maj Journal: Front Psychiatry Date: 2021-12-20 Impact factor: 4.157
Authors: Sonia Dollfus; Armida Mucci; Giulia M Giordano; István Bitter; Stephen F Austin; Camille Delouche; Andreas Erfurth; W Wolfgang Fleischhacker; Larisa Movina; Birte Glenthøj; Karoline Gütter; Alex Hofer; Jan Hubenak; Stefan Kaiser; Jan Libiger; Ingrid Melle; Mette Ø Nielsen; Oleg Papsuev; Janusz K Rybakowski; Gabriele Sachs; Alp Üçok; Francesco Brando; Pawel Wojciak; Silvana Galderisi Journal: Front Psychiatry Date: 2022-01-31 Impact factor: 4.157
Authors: Giulia M Giordano; Luigi Giuliani; Andrea Perrottelli; Paola Bucci; Giorgio Di Lorenzo; Alberto Siracusano; Francesco Brando; Pasquale Pezzella; Michele Fabrazzo; Mario Altamura; Antonello Bellomo; Giammarco Cascino; Anna Comparelli; Palmiero Monteleone; Maurizio Pompili; Silvana Galderisi; Mario Maj Journal: J Clin Med Date: 2021-12-13 Impact factor: 4.241