Psychosocial functioning in patients with chronic schizophrenia: Findings from the NIMH CATIE study
Reduction of psychotic symptoms is a key goal of schizophrenia treatment, but may not translate into meaningful improvement in the day-to-day functioning of affected patients. Psychosocial functioning is strongly correlated with cognitive functioning and negative symptoms, but these domains are also among the most illusive targets of schizophrenia treatment. As a result, despite the clear importance of psychosocial functioning in achieving recovery, improvement in this domain is a severe challenge in schizophrenia treatment. Demonstrable improvement in social relationships, performance of key social roles, and community living skills may substantially lag behind symptomatic improvement. The introduction of second-generation antipsychotics (SGAs) was accompanied by hopes and expectations that they would be superior to first-generation antipsychotics (FGAs) in improving psychosocial functioning. The reasoning was that the putative superior efficacy and reduced side effect burden of SGAs relative to FGAs, would improve social functioning. For example, extrapyramidal symptoms and sedation may make instrumental daily activities difficult; negative symptoms may reduce interest and initiative, and positive symptoms may cause further disorganization and social rejection >The many diverse approaches to evaluating psychosocial functioning and quality of life for individuals with schizophrenia make comparisons across schizophrenia studies difficult. However, the Quality of Life Scale (QLS) is the most widely used clinician-rated scale of psychosocial functioning and assesses social functioning, interpersonal relationships, vocational functioning, and psychological well-being. The scale was originally developed to measure a schizophrenic deficit syndrome, but is now used widely as a proxy measure of community functioning.
