title: 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.
abstract: The aim of this work was to compare achievements in milestones of community functioning in highly disabling psychiatric conditions, including treatment resistant schizophrenia (TRS), schizophrenia (responsive to antipsychotics), bipolar disorder, and anxiety/depressive diseases. Also, we investigated the predictors of community functioning outcomes across several domains. Among consecutive patients screened, 188 met inclusion criteria and 118 ultimately entered the study. Diagnosis of TRS was made by stringent criteria, including historic and perspective evaluations and excluding potential confounding factors. Achievements in functional milestones of everyday living were recorded. Performances in discrete cognitive tasks were assessed. The Positive and Negative Syndrome Scale, the Personal and Social Performance Scale, the Drug Attitude Inventory-10, and the Quality of Life Enjoyment and Satisfaction Questionnaire were administered. TRS patients showed the highest impairment in community functioning among diagnostic groups. TRS was found to have more severe psychopathology, more impaired cognitive functioning, and poorer psychosocial adjustment compared to all the other groups. In the whole sample, the main predictors of community functioning were the diagnostic group (with TRS diagnosis associated with worst functioning) and achievements in the other functional milestones. In psychotic patients, however, the main predictors of community functioning were clinical and psychopathological variables. These results may support the hypothesis that TRS represents a separate schizophrenia subtype, with its own neurobiology, psychopathology and clinical course. Our results identify a group of modifiable predictors to be addressed to prevent community disability.
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
authors: Felice
authors: F
authors: Iasevoli
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
authors: Sara
authors: S
authors: Giordano
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
authors: Raffaele
authors: R
authors: Balletta
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
authors: Gianmarco
authors: G
authors: Latte
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
authors: Maria Vittoria
authors: MV
authors: Formato
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
authors: Emiliano
authors: E
authors: Prinzivalli
authors: National Health Service, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy; Department of Neurosciences and Imaging, University G. D'Annunzio, Chieti, Italy.
authors: Domenico
authors: D
authors: De Berardis
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy; National Health Service, Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, Hospital "Maria SS dello Splendore", Giulianova, TE, Italy.
authors: Carmine
authors: C
authors: Tomasetti
authors: Outpatient Unit on Treatment Resistant Psychosis, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy. Electronic address: adebarto@unina.it.
authors: Andrea
authors: A
authors: de Bartolomeis
mesh_terms: D000124:Achievement; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000453:epidemiology; D001714:Bipolar Disorder / Q000453:epidemiology; D003071:Cognition; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000503:physiopathology; D004351:Drug Resistance; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D012919:Social Behavior; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
keywords: Cognitive; PANSS; Psychosis; Psychosocial; Quality of life