Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2014-0028
Trends in Psychiatry and Psychotherapy
Original Article

Functioning in early and late stages of schizophrenia

Funcionalidade nos estágios inicial e final da esquizofrenia

Leonardo Gazzi Costa; Raffael Massuda; Mariana Pedrini; Ives Cavalcante Passos; Leticia Sanguinetti Czepielewski; Elisa Brietzke; Clarissa S. Gama

Downloads: 0
Views: 342

Abstract

INTRODUCTION: Schizophrenia is frequently associated with a debilitating course and prominent impairment in social and occupational functioning. Although the criteria for classification into stages have not been defined in the literature, illness duration and functioning seem to be good candidates.OBJECTIVE:To compare functioning of patients with schizophrenia at different stages of the disease (early vs. late) and healthy sex- and age-matched controls.METHODS: This double-blinded, case-controlled study included 79 individuals: 23 patients with schizophrenia diagnosed up to 5 years earlier; 19 patients with schizophrenia diagnosed at least 20 years earlier; and healthy matched controls. Diagnoses were established using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I Disorder. Functioning was assessed using the Functioning Assessment Short Test (FAST).RESULTS: Patients in the early stage had significantly higher scores than healthy controls in total FAST and in autonomy, occupational functioning, cognitive functioning and interpersonal relationships. Individuals in the late stage had significantly poorer functioning than controls in all domains. The comparison of functioning between the two groups of patients revealed no significant differences, except in occupational functioning, in which late stage patients had a poorer performance.CONCLUSION: Functioning impairment in schizophrenia tends to remain stable despite illness duration. Therefore, functioning should be effectively assessed at an early stage, as illness duration alone may not be the most reliable criterion to stage patients with schizophrenia.

Keywords

Cognition, functioning, psychosis, schizophrenia, staging

Resumo

INTRODUÇÃO:A esquizofrenia está frequentemente associada a um curso debilitante e a um importante comprometimento no funcionamento social e ocupacional. Embora os critérios para classificação em diferentes estágios ainda não tenham sido definidos, a duração da doença e a funcionalidade têm sido apontadas como bons candidatos.OBJETIVO:Comparar a funcionalidade de indivíduos com esquizofrenia no estágio inicial e final com controles saudáveis correspondentes em idade e sexo.MÉTODOS: Neste estudo caso-controle, duplo-cego, foram incluídos 79 pacientes: 23 com diagnóstico de esquizofrenia feito até 5 anos atrás (estágio inicial); 19 diagnosticados há pelo menos 20 anos (estágio final); e controles saudáveis pareados. O diagnóstico foi estabelecido pela Entrevista Clínica Estruturada para Transtornos do Eixo I do Manual Diagnóstico e Estatístico de Transtornos Mentais, 4ª edição (DSM-IV). A funcionalidade foi avaliada através da escala Teste Breve de Avaliação Funcional (FAST).RESULTADOS: Os pacientes em estágio inicial tiveram escores significativamente maiores do que controles saudáveis na escala FAST (escore total e domínios autonomia, funcionamento ocupacional, funcionamento cognitivo e relações interpessoais). Os indivíduos em estágio final apresentaram funcionalidade pior que os controles em todos os domínios. A comparação entre os dois grupos não mostrou diferenças, exceto no funcionamento ocupacional, em que os pacientes em estágio final apresentaram um desempenho pior.CONCLUSÃO: O prejuízo da funcionalidade na esquizofrenia tende a permanecer estável ao longo da doença. Portanto, a funcionalidade deve ser avaliada nos estágios iniciais da doença, já que a duração da doença por si só pode não ser o critério mais confiável para definir o estágio de pacientes com esquizofrenia.

Palavras-chave

Cognição, funcionalidade, psicose, esquizofrenia, estadiamento

References

Tohen M, Strakowski SM, Zarate C Jr, Hennen J, Stoll AL, Suppes T. The McLean-Harvard first-episode project: 6-month symptomatic and functional outcome in affective and nonaffective psychosis. Biol Psychiatry. 2000;48:467-76.

González-Ortega I, Rosa A, Alberich S, Barbeito S, Vega P, Echeburúa E. Validation and use of the Functioning Assessment Short Test in first psychotic episodes. J Nerv Ment Dis. 2010;198:836-40.

Fava GA, Kellner R. Staging: a neglected dimension in psychiatric classification. Acta Psychiatr Scand.. 1993;87:225-30.

Wood SJ1, Yung AR, McGorry PD, Pantelis C. Neuroimaging and treatment evidence for clinical staging in psychotic disorders: from the at-risk mental state to chronic schizophrenia. Biol Psychiatry. 2011;70:619-25.

Scott J, Leboyer M, Hickie I, Berk M, Kapczinski F, Frank E. Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value. Br J Psychiatry. 2013;202:243-5.

Mausbach BT, Moore R, Bowie C, Cardenas V, Patterson TL. A review of instruments for measuring functional recovery in those diagnosed with psychosis. Schizophr Bull.. 2009;35:307-18.

Pinkham AE, Penn DL, Perkins DO, Graham KA, Siegel M. Emotion perception and social skill over the course of psychosis: a comparison of individuals "at-risk" for psychosis and individuals with early and chronic schizophrenia spectrum illness. Cogn Neuropsychiatry. 2007;12:198-212.

Ruiz-Iriondo M, Salaberria K, Echeburúa E. Schizophrenia: analysis and psychological treatment according to the clinical staging. Actas Esp Psiquiatr.. 2013;41:52-9.

Rosa AR, Sánchez-Moreno J, Martínez-Aran A, Salamero M, Torrent C, Reinares M. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health. 2007:3:5.

Lee J, Takeuchi H, Fervaha G, Bhaloo A, Powell V, Remington G. Relationship between clinical improvement and functional gains with clozapine in schizophrenia. Eur Neuropsychopharmacol. 2014;24:1622-9.

Zortea K, Magalhaes PV, Rosa AR, Lucena DF, Guimarães LR, Francesconi LP. Concurrent validity and reliability of the Brazilian version of the Functioning Assessment Short Test in patients with schizophrenia. Value Health Reg Issues. 2012;1:244-7.

de Jong A, Giel R, Slooff CJ, Wiersma D. Social disability and outcome in schizophrenic patients. Br J Psychiatry. 1985;147:631-6.

Hoff AL, Kremen WS. Neuropsychology in schizophrenia: an update. Curr Opin Psychiatry. 2003;16:149-55.

Hoff AL, Svetina C, Shields G, Stewart J, DeLisi LE. Ten year longitudinal study of neuropsychological functioning subsequent to a first episode of schizophrenia. Schizophr Res.. 2005;78:27-34.

Addington J, Addington D. Cognitive functioning in first-episode schizophrenia. J Psychiatry Neurosci.. 2002;27:188-92.

Riley EM, McGovern D, Mockler D, Doku VC, OCeallaigh S, Fannon DG. Neuropsychological functioning in first-episode psychosis--evidence of specific deficits. Schizophr Res.. 2000;43:47-55.

Hoff AL, Sakuma M, Wieneke M, Horon R, Kushner M, DeLisi LE. Longitudinal neuropsychological follow-up study of patients with first-episode schizophrenia. Am J Psychiatry. 1999;156:1336-41.

Heaton RK, Gladsjo JA, Palmer BW, Kuck J, Marcotte TD, Jeste DV. Stability and course of neuropsychological deficits in schizophrenia. Arch Gen Psychiatry. 2001;58:24-32.

Cirillo MA, Seidman LJ. Verbal declarative memory dysfunction in schizophrenia: from clinical assessment to genetics and brain mechanisms. Neuropsychol Rev.. 2003;13:43-77.

Aleman A, Hijman R, de Haan EH, Kahn RS. Memory impairment in schizophrenia: a meta-analysis. Am J Psychiatry. 1999;156:1358-66.

Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998;12:426-45.

616b1458a953952e320c4cf6 trends Articles
Links & Downloads

Trends Psychiatry Psychother

Share this page
Page Sections