Global functioning among middle-aged patients with chronic schizophrenia: the role of medication, working memory and verbal comprehension
Abstract
The chronic phase of schizophrenia is characterized by illness progression and patients encountering difficulties to return to premorbid level of functioning. The objective of this study was to describe the characteristics of a sample of patients with chronic schizophrenia, as well to assess differences between patients under and over 45 years of age. In a clinical sample of 77 chronic schizophrenia patients, we assessed basic symptoms, cognitive performance, social functioning and quality of life. All participants obtained very high scores in residual symptoms, and no differences in sociodemographic or clinical characteristics between the age groups were found. Younger patients had better cognitive performance and older patients obtained better scores for social functioning and quality of life. Number of psychotropic drugs, verbal learning delayed of SCIP, errors in WCST, Similarities and Digit Symbol Coding of WAIS were the most important variables to predict global functioning of patients over 45 years old. Increasing our understanding of differences in characteristics of the chronic phase of the illness and the profile of functioning at different ages, may help us design intervention strategies to improve adaptation in young and middle-aged patients with chronic schizophrenia.
Downloads
References
Angermeyer, M. C., Beck, M., Dietrich, S., & Holzinger, A. (2004). The stigma of mental illness: patients’ anticipations and experiences. International Journal of Social Psychiatry, 50, 153-162. https://doi.org/10.1177/0020764004043115.
Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake S. (1990). The social functioning scale: the development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157, 853-859.
Bowie, C. R., Reichenberg, A., McClure, M. M., Leung, W. L., & Harvey, P. D. (2008). Age- associated differences in cognitive performance in older community welling schizophrenia patients: Differential sensitivity of clinical neuropsychological and experimental information processing test. Schizophrenia Research, 106, 50-58.https://dx.doi.org/10.1016%2Fj.schres.2007.10.026.
Bozikas, V. P., Kosmidis, M. H., Kiosseoglou, G., & Karavatos, A. (2006). Neuropsychological profile of cognitively impaired patients with schizophrenia. Comprehensive Psychiatry, 47, 136-143. https://doi.org/10.1016/j.comppsych.2005.05.002.
Carceller, M., Portella, M. J., Carmona, C., Rametti, G., Puigdemont, D., Figueras, M., Fernández-Vidal, A., Villalta, L., & Álvarez, E. (2014). Efectos neuropsicológicos del tratamiento de mantenimiento con Clozapina en el trastorno psicótico resistente. Actas Españolas de Psiquiatría, 42, 68-73.
Carson, N. J. (2006). Fisiología de la conducta. Madrid: Pearson.
Cohen, C. I., Vahia, I., Reyes, P., Diwan, S., Bankole, A. O., & Palekar, N. (2008). Focus on geriatric psychiatry: schizophrenia in later life: clinical symptoms and social well-being. Psychiatric Services, 9, 232-234. https://doi.org/10.1176/ps.2008.59.3.232.
Comparelli, A., de Carolis, A., Emili, E., Rigucci, S., Falcone, I., Corigliano, V., Curto, M., Trovini, G., Dehning, J., Kotzalidis, G. D., & Girardi, P. (2014). Basic symptoms and psychotic symptoms: the relationships in the at risk mental states, first episode and multi-episode schizophrenia. Comprehensive Psychiatry, 55, 785-791. https://doi.org/10.1016/j.comppsych.2014.01.006.
Corrigan, P. W., & Watson, A. (2002). The paradox of self-stigma and mental illness. Clinical Psychology; Research & Practice, 9, 35-53. https://doi.org/10.1093/clipsy.9.1.35.
Dickinson, D., Ramsey, M. E., & Gold, J. M. (2007). Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry, 64, 532-542. https://doi.org/10.1001/archpsyc.64.5.532.
Fernández-Martin, L. C., Fombellida, C., & Montero-Fernández, C. (2014). Behavioral activation therapy for negative symptoms in schizophrenia: a clinical case. Norte de Salud Mental 49, 76-81.
Fervaha, G., Foussias, G., Agid, O., & Remington, G. (2014). Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia. Acta Psychiatrica Scandinavica, 130, 290-299. https://doi.org/10.1111/acps.12289.
Foussias, G., Mann, S., Zakzanis, K. K., van Reekum, R., Agid, O., & Remington, G. (2011). Prediction of longitudinal outcome in schizophrenia: the impact of baseline motivational deficits. Schizophrenia Research, 132, 427-439.
https://doi.org/10.1016/j.schres.2011.06.026.
Friedman, J. I., Harvey, P. D., Coleman, T., Moriarty, P. J., Bowie, C. R., Parrella, M., White, L., Adler, D., & Davies, K. L. (2001). Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: a comparison with Alzheimer´s disease and normal aging. American Journal of Psychiatry, 158, 1441-1448. http://doi.org/10.1176/appi.ajp.158.9.1441.
Fucetola, R., Seidman, L. J., Kremen, W. S., Faraone, S. V., Goldstein, J. M., &Tsuang, M. T. (2000). Age and neuropsychologic function in schizophrenia: a decline in executive abilities beyond that observed in healthy volunteers. Biological Psychiatry, 48, 137-146. http://psycnet.apa.org/doi/10.1016/S0006-3223(00)00240-7.
Fuentes-Durá, I., Romero-Peris, M., Dasí-Vivó, C., & Ruiz-Ruiz, J. C. (2010). Versión abreviada del WAIS III para su uso en la evaluación de pacientes con esquizofrenia. Psicothema, 22, 202-207.
Fusar-Poli, P., Borqwardt, S., Bechdolf, A., Addington, J., Riecher-Rössler, A., Schultze-Lutter, F., Keshavan, M., Wood, S., Ruhrmann, S., Seidman, L. J., Valmaggia, L., Cannon, T., Velthorst, E., de Haan, L., Cornblatt, B., Bonoldi, I., Birchwood, M., McGlashan, T., Carpenter, W., McGorry, P., Klosterkötter, J., McGuire, P., & Young, A. (2013). The psychosis high-risk state: a comprehensive state of the art review. JAMA Psychiatry, 70, 107-120. https://doi.org/10.1001/jamapsychiatry.2013.269.
Gabaldon, O., Ruiz-Iriondo, M., & Bobowik, M. (2013). Multi-informant perception of quality of life and adaptation in chronic schizophrenia. Spanish Journal of. Psychology, 16, 1-8.http://doi.org/10.1017/sjp.2013.98.
García-Portilla, P., & Bobes, J. (2013). Ante el nuevo reto de identificar el síndrome negativo de la esquizofrenia. Revista de Psiquiatría y Salud Mental, 6, 141-143. http://doi.org/10.1016/j.rpsmen.2013.10.001.
Gómez-Benito, J., Guilera, G., Pino, O., Rojo, E., Tabarés-Seisdedos, R., Safont, G., Martinez-Arán, A., Franco, M., Cuesta, M. J., Crespo-Facorro, B., Bernardo, M., Vieta, E., Purdon, S. E., Mesa, F., Rejas, J., and the Spanish Working Group in Cognitive Function. (2013). The screen for cognitive impairment in psychiatry: diagnostic-specific standardization in psychiatric ill patients. BMC Psychiatry, 13, 127.https://doi.org/10.1186/1471-244X-13-127.
Granholm, E., Morris, S., Asarnov, R. F., Chock, D., & Jeste, D. V. (2000) .Accelerated age related decline in processing resources in schizophrenia: evidence from pupillary responses recorded during the span of apprehension task. Journal of the International Neuropsychological Society, 6, 30-43.
Gray, J. A., & Roth, B. L. (2007). Molecular targets for treating cognitive dysfunction in schizophrenia. Schizophrenia Bulletin, 33, 1100-1119. https://dx.doi.org/10.1093%2Fschbul%2Fsbm074.
Gross, G., & Huber, G. (1996). The true onset of schizophrenia in its meaning for the view of the disorder. Neurology, Psychiatry and Brain Research, 4, 93-102.
Häfner, H., & an der Heiden, W. (2008). Course and outcome, in: K. T. Mueser, & D. V Jeste (Eds.), Clinical handbook of schizophrenia. New York: The Guilford Press.
Harvey, P. D., Silverman, J. M., Mohs, R. C., Parrella, M., White, L., Powchik, P., Davidson, M., & Davis, K. L. (1999). Cognitive decline in late-life schizophrenia: a longitudinal study of geriatric chronically hospitalized patients. Biological Psychiatry, 45, 32-40.
Harvey, P. D., & Strassing, M. (2012). Predicting the severity of everyday functional disability in people with schizophrenia: cognitive deficits, functional capacity, symptoms and health status. World Psychiatry, 11, 73-79.
Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin card sorting test manual (revised an expanded). Odessa, Florida: Psychological Assessment Resources, Inc.
Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (2009). Test de clasificación de tarjetas de Wisconsin. Madrid: TEA Ediciones.
Jimeno-Bulnes, N., Jimeno-Valdés, A., & Vargas-Aragón, M. L. (1996). El síndrome psicótico y el inventario de Frankfurt: conceptos y resultados. Barcelona: Springer-Verlag.
Jobe, T. H., & Harrow, M. (2005). Long term outcome in patients with schizophrenia: a review. Canadian Journal of Psychiatry, 58, 892-900. https://doi.org/10.1177/070674370505001403.
Kirpatrick, B., Fenton, W., Carpenter, W. T., & Marder, S. T. (2006). The NIMH-MATRICS consensus statement on negative symptoms. Schizophrenia Bulletin, 32, 296-303. https://doi.org/10.1093/schbul/sbj053.
Knowles, E. M., David, A. S., & Reichenberg, A. (2010). Processing speed deficits in schizophrenia: re-examining the evidence. American Journal of Psychiatry, 167, 828-835. https://doi.org/10.1176/appi.ajp.2010.09070937.
McGrath, J., Saha, S., Welham, J., El Saadi, O., MacCauley, C., & Chant, D. (2004). A systematic review of the incidence rate of schizophrenia: the distribution of rates and influence of sex, urbanicity, migrant status and methodology. BMC Medicine, 2, 13. https://doi.org/10.1186/1741-7015-2-13.
Miret, S., Fatjó-Vilas, M., Peralta, V., & Fañanás, L. (2016). Síntomas básicos en la esquizofrenia, su estudio clínico y relevancia en investigación. Revista de Psiquiatría y Salud Mental, 9, 111-122. https://doi.org/10.1016/j.rpsm.2015.10.007.
Mueller, D. R., Schmidt, S. J., & Roder, V. (2013). Integrated psychological therapy: effectiveness in schizophrenia inpatient settings related to patients’ age. American Journal of Geriatric Psychiatry, 21, 231-241. https://doi.org/10.1016/j.jagp.2012.12.011.
NICE (National Institute for Health and Clinical Excellence) (2014). Psychosis and schizophrenia in adults: prevention and management. [CG78]. Retrieved from https://www.nice.org.uk/guidance/cg178.
Oliver, J. P. J., Huxley, P. J., Priebe, S., & Kaiser, W. (1997). Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Social Psychiatry and Psychiatric Epidemiology, 32, 76-83.
Orellana, G., & Slachevsky, A. (2013). Executive functioning in schizophrenia. Frontiers in Psychiatry, 24, 2-35. https://doi.org/10.3389/fpsyt.2013.00035.
Overall, L. E., & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports, 10, 799-812. http://psycnet.apa.org/doi/10.2466/pr0.1962.10.3.799.
Peralta, V., & Cuesta, M. J. (1994). Psychometric properties of the positive and negative síndrome scale (PANSS) in schizophrenia. Psychiatry Research, 53, 31-40.
Pino, O., Guilera, G., Gómez, J., Rojo, E. J., Vallejo, J., & Purdon, S. E. (2006). Escala breve para evaluar el deterioro cognitivo en pacientes psiquiátricos. Psycothema, 18, 447-452.
Purdon, S. E. (2005). The Screen for Cognitive Impairment in Psychiatry (SCIP): instructions and three alternate forms. Edmonton, Alberta: PNL, Inc.
Rocca, P., Montemagni, C., Mingrone, C., Crivelli, B., Sigaudo, M., & Bogetto, F. (2013). A cluster-analytical approach toward real-world outcome in outpatients with stable schizophrenia. European Psychiatry, 32 ,48-54. https://doi.org/10.1016/j.eurpsy.2015.11.007.
Saha, S., Chant, D., Welham, J., & McGrath, J. (2005). A systematic review of the prevalence schizophrenia. PLos Medicine, 2. https://doi.org/10.1371/journal.pmed.0020141.
Schultze-Lutter, F. (2009). Subjective symptoms of schizophrenia in research and the clinic: the basic symptoms concept. Schizophrenia Bulletin, 35, 5-8.https://dx.doi.org/10.1093%2Fschbul%2Fsbn139.
Schultze-Lutter, F., Ruhrmann, S., & Klosterkötter, J. (2006). Can schizophrenia be predicted phenomenologically? In: J. O. Johannesen, B. V. Martindale & J. Cullberg (Eds.), Evolving psychosis: different stages, different treatments. New York: Routledge.
Sullwood, L., & Huber, G. (1986). Schizophrene Basisstörungen. Berlin: Springer.
Torres, A., & Olivares, J. M. (2005). Validación en castellano de la Social Functioning Scale. Actas españolas de psiquiatría, 33, 216-220.
Vauth, R., Kleim, B., Wirtz, M., & Corrigan, P. W. (2007). Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatry Research, 50, 71-80. https://doi.org/10.1016/j.psychres.2006.07.005.
Vázquez-Barquero, J. L., Gaite, L., Ramírez, N., García-Usieto, E., Borra-Ruiz, C., Sanz-García, O., Bobes, J., & Oliver, J. (1997). Desarrollo de la versión española del perfil de Calidad de Vida de Lancashire (LQoLP). Archivos de Neurobiología, 60, 125-139.
Weschler, D. (1999). WAIS -III. Escala de inteligencia de Wechsler para adultos-III. Madrid:TEA Ediciones.
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioral Disorders. Clinical descriptions and diagnostic guidelines. Geneva: WHO.
World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310, 2191-2194. https://doi.org/10.1001/jama.2013.281053.
The works published in this journal are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) retains the property rights (copyright) of published works, and encourages and enables the reuse of the same under the license specified in paragraph 2.
© Servicio de Publicaciones, Universidad de Murcia, 2022
2. The works are published in the online edition of the journal under a Creative Commons Reconocimiento-CompartirIgual 4.0 (legal text). You can copy, use, distribute, transmit and publicly display, provided that: i) you cite the author and the original source of publication (journal, editorial and URL of the work), ii) are not used for commercial purposes, iii ) mentions the existence and specifications of this license.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
3. Conditions of self-archiving. Is allowed and encouraged the authors to disseminate electronically pre-print versions (version before being evaluated and sent to the journal) and / or post-print (version reviewed and accepted for publication) of their works before publication, as it encourages its earliest circulation and diffusion and thus a possible increase in its citation and scope between the academic community. RoMEO Color: Green.
