Disability and schizophrenia: a systematic review of experienced psychosocial difficulties

BMC Psychiatry

Somnath Chatterji⁴  Jerome Bickenbach²  Alarcos Cieza¹  Carla Sabariego¹  Anna Chrostek³  Marta Anczewska³  Piotr Świtaj³ 

[1] Research Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany;Swiss Paraplegic Research, Nottwil, Switzerland;I Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, Warsaw, 02-957, Poland;Health Statistics and Informatics, WHO, Geneva, Switzerland

关键词: ICF;    Functioning;    Disability;    Psychosocial difficulties;    Schizophrenia;   

Others  :  1124239
DOI  :  10.1186/1471-244X-12-193

 received in 2012-05-25, accepted in 2012-11-06,  发布年份 2012

【 摘 要 】

Background

Schizophrenia is a significantly disabling disease that affects all major areas of life. There is a lack of comprehensive synthesis of research findings on the full extent of psychosocial difficulties (PSDs) experienced by people living with schizophrenia. This paper provides a systematic review of the literature concerning PSDs and their associated factors in schizophrenia. PSDs were conceptualized in accordance with the International Classification of Functioning, Disability and Health (ICF) as disabilities, in particular impairments of mental functions, activity limitations and participation restrictions.

Methods

An electronic search using MEDLINE and PsychINFO plus a manual search of the literature was performed for qualitative and longitudinal studies published in English between 2005 and 2010 that examined PSDs in persons with schizophrenia. The ICF was used as a conceptual framework.

Results

A total of 104 papers were included. The most frequent PSDs addressed in the literature were not specific ones, directly linkable to the ICF categories of mental functions, activity limitations or participation restrictions, but broad areas of psychosocial functioning, such as psychopathological symptoms (53% of papers) or global disability and functioning (37%). Among mental functions, the most extensively studied were cognitive functions (27%) and emotional functions (27%). Within the domain of activities and participation, the most widely investigated were difficulties in relationships with others (31%) and employment (20%). Of the factors associated with the intensity or course of PSDs, the most commonly identified were treatment modalities (56%), psychopathological symptoms (26%), and socio-demographic variables (24%). Medication tended to improve the most relevant PSD, but at the same time was the only consistently reported determinant of onset of PSDs (emerging as unwanted side-effects).

Conclusions

The present review illustrates the remarkably broad scope and diversity of psychosocial areas affected in schizophrenia and shows how these areas are interconnected and how they interact with contextual factors. The need for a shift in focus of schizophrenia research is suggested – from an excessive reliance on global measures of psychopathology and disability for defining outcomes to the creation of profiles of specific PSDs that have a more direct bearing on the disabling experience and real-world functioning of patients and can serve to guide interventions and monitoring over time.

【 授权许可】

   
2012 Switaj et al.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Tandon R, Nasrallah HA, Keshavan MS: Schizophrenia, “just the facts” 4. Clinical features and conceptualization. Schizophr Res 2009, 110:1-23.
• [2]Jobe TH, Harrow M: Long-term outcome of patients with schizophrenia: a review. Can J Psychiatry 2005, 50:892-900.
• [3]Tandon R, Keshavan MS, Nasrallah HA: Schizophrenia, "just the facts": what we know in 2008 part 1: overview. Schizophr Res 2008, 100:4-19.
• [4]Ritsner MS, Gibel A: Quality of life impairment syndrome in schizophrenia. In Quality of life impairment in schizophrenia, mood and anxiety disorders: new perspectives on research and treatment. Edited by Ritsner MS, Awad AG. Dordrecht: Springer; 2007:173-226.
• [5]Tandon R, Nasrallah HA, Keshavan MS: Schizophrenia, "just the facts" 5. Treatment and prevention. Past, present and future. Schizophr Res 2010, 122:1-23.
• [6]Sartorius N, Schulze H: Reducing the stigma of mental illness. A report from a global programme of the World Psychiatric Association. Cambridge: Cambridge University Press; 2005.
• [7]Burton S: Symptom domains of schizophrenia: the role of atypical antipsychotic agents. J Psychopharmacol 2006, 20(6 Suppl):6-19.
• [8]Mäkinen J, Miettunen J, Isohanni M, Koponen H: Negative symptoms in schizophrenia – a review. Nord J Psychiatry 2008, 62:334-341.
• [9]Szöke A, Trandafir A, Dupont M-E, Méary A, Schürhoff F, Leboyer M: Longitudinal studies of cognition in schizophrenia: meta-analysis. Br J Psychiatry 2008, 192:248-257.
• [10]Penn DL, Sanna LJ, Roberts DL: Social cognition in schizophrenia: an overview. Schizophr Bull 2008, 34:408-411.
• [11]Cohen AS, Minor KS: Emotional experience in patients with schizophrenia revisited: meta-analysis of laboratory studies. Schizophr Bull 2010, 36:143-150.
• [12]Meesters PD, Stek ML, Comijs HC, de Haan L, Patterson TL, Eikelenboom P, Beekman AT: Social functioning among older community-dwelling patients with schizophrenia: a review. Am J Geriatr Psychiatry 2010, 18:862-878.
• [13]Marwaha S, Johnson S: Schizophrenia and employment. Soc Psychiatry Psychiatr Epidemiol 2004, 39:337-349.
• [14]Eack SM, Newhill CE: Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis. Schizophr Bull 2007, 33:1225-1237.
• [15]Figueira ML, Brissos S: Measuring psychosocial outcomes in schizophrenia patients. Curr Opin Psychiatry 2011, 24:91-99.
• [16]World Health Organization: International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization; 2001.
• [17]Cieza A, Geyh S, Chatterji S, Kostanjsek N, Üstün B, Stucki G: ICF linking rules: an update based on lessons learned. J Rehabil Med 2005, 37:212-218.
• [18]Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S: Guidance on the conduct of narrative synthesis in systematic reviews: a product from the ESRC Methods Programme. Lancaster: Institute for Health Research, Lancaster University; 2006.
• [19]National Institute for Health and Clinical Excellence: The guidelines manual. London: National Institute for Health and Clinical Excellence; 2009.
• [20]Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987, 13:261-276.
• [21]Overall JE, Gorham DR: The brief psychiatric rating scale. Psychol Rep 1962, 10:799-812.
• [22]Heinrichs DW, Hanlon TE, Carpenter WT: The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984, 10:388-398.
• [23]Reitan RM, Wolfson D: The Halstead-Reitan Neuropsychological Test Battery: theory and clinical interpretation. Tucson: Neuropsychology Press; 1985.
• [24]Cornblatt BA, Lenzenweger MF, Erlenmeyer-Kimling L: The continuous performance test, identical pairs version: II. Contrasting attentional profiles in schizophrenic and depressed patients. Psychiatry Res 1989, 29:65-85.
• [25]American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 4th edition. Washington: American Psychiatric Association; 1994.
• [26]Rey A: L’examen clinique en psychologie. Paris: Presses Universitaires de France; 1964.
• [27]Andreasen NC: Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa; 1983.
• [28]Golden CJ: Stroop Color and Word Test: a manual for clinical and experimental uses. Chicago: Stoelting; 1978.
• [29]Naber D: A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables. Int Clin Psychopharmacol 1995, 10(suppl. 3):133-138.
• [30]Üstün TB, Kostanjsek N, Chatterji S, Rehm J: Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva: World Health Organization; 2010.
• [31]Haro JM, Kamath SA, Ochoa S, Novick D, Rele K, Fargas A, et al.: The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand 2003, 107(suppl. 416):16-23.
• [32]Montgomery SA, Åsberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979, 134:382-389.
• [33]Wechsler D: Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation; 1981.
• [34]Wechsler D: Wechsler Memory Scale-Revised. New York: Psychological Corporation; 1987.
• [35]Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G: Wisconsin Card Sorting Test manual: revised and expanded. Odessa: Psychological Assessment Resources; 1993.
• [36]Juckel G, Morosini PL: The new approach: psychosocial functioning as a necessary outcome criterion for therapeutic success in schizophrenia. Curr Opin Psychiatry 2008, 21:630-639.
• [37]Angermeyer MC, Holzinger A: Is there currently a boom of stigma research in psychiatry? An analysis of scientific journals. Psychiat Prax 2005, 32:399-407.
• [38]Livingston JD, Boyd JE: Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med 2010, 71:2150-2161.
• [39]Cabello M, Mellor-Marsá B, Sabariego C, Cieza A, Bickenbach J, Ayuso-Mateos JL: Psychosocial features of depression: a systematic literature review. J Affect Disord 2012, 141:22-33.
• [40]Ávila CC, Cabello M, Cieza A, Vieta E, Ayuso-Mateos JL: Functioning and disability in bipolar disorders: a systematic review of literature using the ICF as a reference. Bipolar Disord 2010, 12:473-482.
• [41]Lysaker PH, Bell MD, Kaplan E, Bryson G: Personality and psychosocial dysfunction in schizophrenia: the association of extraversion and neuroticism to deficits in work performance. Psychiatry Res 1998, 80:61-68.
• [42]Lysaker PH, Taylor AC: Personality dimensions in schizophrenia: associations with symptoms and coping concurrently and 12 months later. Psychopathology 2007, 40:338-344.
• [43]Mortimer AM: Symptom rating scales and outcome in schizophrenia. Br J Psychiatry 2007, 191(suppl. 50):s7-s14.
• [44]McCabe R, Saidi M, Priebe S: Patient-reported outcomes in schizophrenia. Br J Psychiatry 2007, 191(suppl. 50):s21-s28.
• [45]Alvarez AS: The application of the international classification of functioning, disability, and health in psychiatry: possible reasons for the lack of implementation. Am J Phys Med Rehabil 2012, 92(13 suppl. 1):s69-s73.