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. 2024 Aug 23:15:1444843.
doi: 10.3389/fpsyt.2024.1444843. eCollection 2024.

Predictors of functioning in treatment-resistant schizophrenia: the role of negative symptoms and neurocognition

Yanhui Li  1 , Mei San Ang  2 , Jie Yin Yee  2 , Yuen Mei See  2 , Jimmy Lee  1   3   4
Affiliations

Predictors of functioning in treatment-resistant schizophrenia: the role of negative symptoms and neurocognition

Yanhui Li et al. Front Psychiatry. .

Abstract

Introduction: Predictors of functioning are well-studied in schizophrenia, but much less so in treatment-resistant schizophrenia (TRS). In this study, we aim to investigate contributions of schizophrenia symptom domains and neurocognition to predict functioning in a TRS population (n = 146).

Methods: Participants were assessed on the Positive and Negative Syndrome Scale (PANSS), to calculate scores for five symptom factors (Positive, Negative, Cognitive, Depressive and Hostility) and two negative symptom constructs (Diminished Expressivity (DE), and Social Anhedonia (SA) as part of the Motivation and Pleasure-related dimension), based on a previously validated model, modified in accordance with EPA guidelines on negative symptoms assessment. Neurocognition was assessed with symbol coding and digit sequencing tasks from the Brief Assessment of Cognition in Schizophrenia (BACS). Functioning was assessed with the Social and Occupational Functioning Assessment Scale (SOFAS), employment status and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Multiple regression analyses were performed on psychopathology scores and BACS scores against all three measures of functioning, controlling for age and sex. For WHODAS, regression with PANSS scores of significant symptom factors were also performed.

Results: A lower severity of negative symptoms in the SA dimension was the strongest predictor of higher functioning across all three functioning measures. Neurocognition, in particular processing speed and attention assessed on the symbol coding task, predicted employment. A lower severity of somatic concerns and depressive symptoms was associated with lesser self-reported disability on WHODAS.

Discussion: This study represents a first attempt at elucidating significant predictors of functioning in TRS. We highlight negative symptoms and neurocognition as important treatment targets to improve functioning in TRS, consistent with previous studies in general schizophrenia.

Keywords: functioning; negative symptoms; neurocognition; social anhedonia; treatment-resistant schizophrenia.

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Conflict of interest statement

JL has received honoraria, served as a consultant or advisory board member from Otsuka, Janssen, Lundbeck, Sumitomo Pharmaceuticals, Boehringer Ingelheim and ThoughtFull World Pte. Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Correll CU, Howes OD. Treatment-resistant schizophrenia: Definition, predictors, and therapy options. J Clin Psychiatry. (2021) 82:36608. doi: 10.4088/JCP.MY20096AH1C - DOI - PubMed
    1. Meltzer HY. Role of clozapine in treatment-resistant schizophrenia. Therapy-Resistant Schizophr. (2010) 26:114–28. doi: 10.1159/000319812 - DOI
    1. Iasevoli F, Giordano S, Balletta R, Latte G, Formato MV, Prinzivalli E, et al. . Treatment resistant schizophrenia is associated with the worst community functioning among severely-ill highly-disabling psychiatric conditions and is the most relevant predictor of poorer achievements in functional milestones. Prog Neuropsychopharmacol Biol Psychiatry. (2016) 65:34–48. doi: 10.1016/J.PNPBP.2015.08.010 - DOI - PubMed
    1. Kennedy JL, Altar CA, Taylor DL, Degtiar I, Hornberger JC. The social and economic burden of treatment-resistant schizophrenia: A systematic literature review. Int Clin Psychopharmacol. (2014) 29:63–76. doi: 10.1097/YIC.0B013E32836508E6 - DOI - PubMed
    1. Yang Z, Lee SH, Abdul Rashid NA, See YM, Dauwels J, Tan BL, et al. . Predicting real-world functioning in schizophrenia: The relative contributions of neurocognition, functional capacity, and negative symptoms. Front Psychiatry. (2021) 12:639536/BIBTEX. doi: 10.3389/FPSYT.2021.639536/BIBTEX - DOI - PMC - PubMed

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