Factors Predicting Personal and Social Performance in Schizophrenia Patients

SuHyuk Chi; Hyun-Ghang Jeong; Moon-soo Lee; Seung-Hyun Kim

doi:10.16946/kjsr.2016.19.2.47

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Chi, Jeong, Lee, and Kim: Factors Predicting Personal and Social Performance in Schizophrenia Patients

Original Article

Korean J Schizophr Res 2016;19(2):47-59.

Published online: 20 January 2016

DOI: https://doi.org/10.16946/kjsr.2016.19.2.47

Factors Predicting Personal and Social Performance in Schizophrenia Patients

SuHyuk Chi, MD, Hyun-Ghang Jeong, MD, PhD, Moon-soo Lee, MD, PhD, Seung-Hyun Kim, MD, PhD

Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

Address for correspondence: Seung-Hyun Kim, Department of Psychiatry, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: 02-2626-3162, Fax: 02-852-1937 E-mail: gurokim@gmail.com

Received 24 June 2016 Revised 27 September 2016 Accepted 28 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Schizophrenia is a chronic psychiatric disorder characterized by its debilitating course. It leads to personal and social dysfunctions, burdening patients and guardians heavily. Enhancing functional outcome is a major treatment goal, but pharmacotherapy alone is usually not enough. Hence, it is important to reveal clinical factors that can predict personal and social performance in schizophrenia patients. Analyze factors influencing personal and social performance in schizophrenia patients.

Methods

66 schizophrenia patients from three University hospitals in Korea were enrolled, completing clinical scales between January 2008 and December 2009. 38 patients dropped out during follow up. 28 patients were included in the final study. Personal and social performance was measured using the Personal and Social Performance scale (PSP) since January 2015. Correlation and multiple regression analyses were performed to reveal associations between demographic and clinical factors and PSP.

Results

: Correlation analyses resulted in statistically significant correlations between CGI-S (r=-0.646, p＜0.01), PANSS (r= −0.419, p＜0.05), KISP (r=-0.523, r＜0.01), KmSWN (r=0.388, p＜0.05), Trail making B (r=0.608, p＜0.01), KDAI (r=0.608, p＜0.01), and PSP. Stepwise multiple regression analyses showed significant models with CGI-S (β=-0.485, p＜0.01), and KDAI (β=0.423, p＜0.01).

Conclusion

Our results show that attitude toward drugs and symptom severity affect a patient's personal and social performance most prominently. We advise to focus on patient education to reinforce attitude toward drugs, and to concentrate on reducing symptom severity to enhance personal and social performance in schizophrenia patients.

Keywords: Schizophrenia, Personal and social functioning, Predicting factor.

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Table 2.

Clinical variables of the study sample

	Total (n=28)
PSP, mean±SD
PSP-A	3.00±1.09
PSP-B	2.14±1.18
PSP-C	3.39±0.99
PSP-D	1.61±0.88
PSP-Total	55.50±15.02
CGI-S, mean±SD	3.39±0.57
PANSS, mean±SD
Positive	11.29±3.200
Negative	15.18±5.890
General	27.00±6.830
Total	53.46±13.52
CDSS, mean±SD	2.68±2.57
KmSWN, mean±SD
Mental functioning	15.89±3.760
Self control	16.50±3.840
Emotional regulation	16.64±3.960
Physical functioning	16.89±3.910
Social integration	15.82±3.020
Total	81.75±15.08
KISP, mean±SD	11.57±5.390
MSPSS, mean±SD
Family	20.89±6.260
Friends	15.32±6.370
Significant other	15.57±7.210
Total	51.79±15.33

PSP: personal and social performance scale, SD: standard deviation, CGI-S: clinical global impression-severity, PANSS: positive and negative symptom scale, CDSS: Calgary depression scale for schizophrenia, KmSWN: Korean modification of the scale to measure subjective well-being under neuroleptic treatment, KISP: Korean version of the revised insight scale of psychosis, MSPSS: multidimensional scale of perceived social support

Table 1.

Sociodemographic characteristics of the e study sample

	Total (n=28)
Sex, male/female	15/13
Age (years), mean±SD	43.82±10.05
Onset age (years), mean±SD	27.82±8.470
Duration of illness (years), mean±SD	16.00±8.620
Frequency of admission (numbers), mean±SD	1.39±1.50
Education (years), mean±SD	13.57±2.780
Marital status, n (%)
Married/Living together	6 (21.4)
Single	19 (67.9)
Divorced/Separated	3 (10.7)
Employment, n (%)
Employed	6 (21.4)
Unemployed	22 (78.6)

SD: standard deviation.

Table 3.

Cognitive functioning of the study sample

	Total (n=28)
KWIS, mean±SD
Verbal	109.00±8.490
Performance	110.67±11.88
Total	111.33±11.17
Verbal fluency, mean±SD
Animal	13.39±3.64
Country	14.32±5.11
Flower	6.96±2.24
Total	34.68±8.50
Trail making, mean±SD
A	44.81±24.51
B	63.28±58.59

SD: standard deviation, KWIS: Korean Wechsler intelligence scale

Table 4.

Drug related variables of the e study sample

	Total (n=28)
Drug adherence, mean±SD	81.29±25.36
KDAI, mean±SD
Positive	2.07±3.24
Negative	1.82±2.07
Total	3.89±3.91
LUNSERS, mean±SD
Extrapyramidal	3.71±2.79
Psychic	10.64±6.660
Anticholinergic	2.64±2.66
Other autonomic	2.64±2.98
Anergic	1.50±2.08
Hormonal	2.25±2.74
Miscellaneous	2.29±1.80
Red herrings	4.54±3.11
Total	25.68±16.71
SD: standard deviation, KDAI: Kore inventory, LUNSERS: Liverpool unive	ean version of drug attitude rsity side effect rating scale

Table 5.

Pearson's correlations between sociodemographic characteristics and PSP

Variable	Personal and social performance scale (PSP)
Variable	Socially useful activities (PSP-A)	Personal and social relationships (PSP-B)	Self-care (PSP-C)	Disturbing and aggressive behavior (PSP-D)	Total
Age	–0.505∗∗	–0.281∗	–0.486∗∗	–0.118	–0.500∗∗
Sex	–0.201∗∗	–0.009∗	–0.066∗∗	–0.158	–0.109∗∗
Education	–0.269∗∗	–0.184∗	–0.566∗∗	–0.209	–0.385∗∗
Onset age	–0.028∗∗	–0.087∗	–0.127∗∗	–0.140	–0.016∗∗
Duration of illness	–0.561∗∗	–0.413∗	–0.441∗∗	–0.275	–0.567∗∗
Frequency of admission	–0.091∗∗	–0.012∗	–0.058∗∗	–0.160	–0.007∗∗

Significant at ∗∗: p＜0.01, ∗: p＜0.05. PSP: personal and social performance scale

Table 6.

Pearson's correlations between clinical variables and PSP

Variable	Personal and social performance scale (PSP)
Variable	Socially useful activities (PSP-A)	Personal and social relationships (PSP-B)	Self-care (PSP-C)	Disturbing and aggressive behavior (PSP-D)	Total
CGI-S	–0.600∗∗	–0.468∗	–0.505∗∗	–0.099	–0.646∗∗
PANSS
Positive	–0.405∗∗	–0.195∗	–0.208∗∗	–0.051	–0.303∗∗
Negative	–0.358∗∗	–0.359∗	–0.468∗∗	–0.144	–0.451∗∗
General	–0.334∗∗	–0.115∗	–0.245∗∗	–0.037	–0.299∗∗
Total	–0.420∗∗	–0.261∗	–0.377∗∗	–0.056	–0.419∗∗
CDSS	–0.119∗∗	–0.009∗	–0.153∗∗	–0.009	–0.019∗∗
KmSWN
Mental functioning	–0.444∗∗	–0.248∗	–0.544∗∗	–0.261	–0.551∗∗
Self control	–0.293∗∗	–0.107∗	–0.394∗∗	–0.072	–0.308∗∗
Emotional regulation	–0.095∗∗	–0.012∗	–0.368∗∗	–0.161	–0.201∗∗
Physical functioning	–0.235∗∗	–0.149∗	–0.322∗∗	–0.056	–0.343∗∗
Social integration	–0.135∗∗	–0.060∗	–0.112∗∗	–0.239	–0.154∗∗
Total	–0.298∗∗	–0.119∗	–0.438∗∗	–0.008	–0.388∗∗
KISP	–0.442∗∗	–0.355∗	–0.386∗∗	–0.183	–0.523∗∗
MSPSS
Family	–0.326∗∗	–0.365∗	–0.446∗∗	–0.006	–0.342∗∗
Friends	–0.086∗∗	–0.214∗	–0.237∗∗	–0.030	–0.096∗∗
Significant other	–0.113∗∗	–0.197∗	–0.384∗∗	–0.072	–0.105∗∗
Total	–0.044∗∗	–0.331∗	–0.461∗∗	–0.049	–0.229∗∗

Significant at ∗∗: p＜0.01, ∗: p＜0.05. PSP: personal and social performance scale, CGI-S: clinical global impression-severity, PANSS: positive and negative symptom scale, CDSS: Calgary depression scale for schizophrenia, KmSWN: Korean modification of the scale to measure subjective well-being under neuroleptic treatment, KISP: Korean version of the revised insight scale of psychosis, MSPSS: multidimensional scale of perceived social support

Table 7.

Pearson's correlations between cognitive functioning and PSP

Variable	Personal and social performance scale (PSP)
Variable	Socially useful activities (PSP-A)	Personal and social relationships (PSP-B)	Self-care (PSP-C)	Disturbing and aggressive behavior (PSP-D)	Total
KWIS
Verbal	–0.501	–0.000	–0.360	–0.228	–0.681
Performance	–0.373	–0.023	–0.040	–0.141	–0.543
Total	–0.293	–0.097	–0.085	–0.058	–0.501
Verbal fluency
Animal	–0.459∗	–0.143	–0.321	–0.085	–0.357
Country	–0.326	–0.119	–0.164	–0.319	–0.211
Flower	–0.122	–0.012	–0.127	–0.144	–0.185
Total	–0.424∗	–0.136	–0.269	–0.266	–0.328
Trail making
A	–0.326	–0.124	–0.398∗	–0.249	–0.358
B	–0.514∗∗	–0.542∗∗	–0.553∗∗	–0.176	–0.608∗∗

Significant at ∗∗: p＜0.01, ∗: p＜0.05. PSP: personal and social performance scale, KWIS: Korean Wechsler intelligence scale

Table 8.

Pearson's correlations between drug related variables and PSP

Variable	Personal and Social Performance Scale (PSP)
Variable	Socially useful activities (PSP-A)	Personal and social relationships (PSP-B)	Self-care (PSP-C)	Disturbing and aggressive behavior (PSP-D)	Total
Drug adherence	–0.166	–0.254	–0.106	–0.047	–0.178
KDAI
Positive	–0.462∗	–0.294	–0.423∗	–0.355	–0.486∗∗
Negative	–0.279	–0.202	–0.270	–0.142	–0.386∗
Total	–0.531∗	–0.351	–0.494∗∗	–0.370	–0.608∗∗
LUNSERS
Extrapyramidal	–0.122	–0.306	–0.082	–0.195	–0.165
Psychic	–0.158	–0.215	–0.342	–0.134	–0.215
Anticholinergic	–0.038	–0.019	–0.183	–0.031	–0.124
Other autonomic	–0.194	–0.036	–0.126	–0.044	–0.152
Anergic	–0.245	–0.015	–0.009	–0.396∗	–0.168
Hormonal	–0.149	–0.080	–0.132	–0.004	–0.045
Miscellaneous	–0.113	–0.002	–0.003	–0.191	–0.079
Red herrings	–0.016	–0.043	–0.197	–0.158	–0.068
Total	–0.022	–0.049	–0.095	–0.097	–0.031

Significant at ∗∗: p＜0.01, ∗: p＜0.05. PSP: personal and social performance scale, KDAI: Korean version of drug attitude inventory, LUNSERS: Liverpool university side effect rating scale

Table 9.

Stepwise multiple linear regression model of clinical variables and PSP

Step	Independent variable	B	SE	β	t	p-value	Model adjusted R²
Model 1: PSP-Total as dependent variable							53.6%
1	CGI-S	–12.839	3.755	–0.485	–3.419	0.002
2	KDAI	–01.625	0.545	–0.423	–2.983	0.006
Model 2: PSP-A (Socially useful activities) as dependent variable							42.4%
1	CGI-S	0–0.893	0.303	–0.465	–0.465	0.007
2	KDAI	0–0.098	0.044	–0.353	–0.353	0.034
Model 3: PSP-B (Personal and social relationships) as dependent variable							26.6%
1	Trail making B	0–0.011	0.003	–0.542	–3.287	0.003
Model 4: PSP-C (Self-care) as dependent variable							27.9%
1	Trail making B	0–0.009	0.003	–0.553	–3.382	0.002
Model 5: PSP-D (Disturbing and aggressive behavior) as dependent variable							No applicable model

Forward selection, probability of F to enter ≤0.05. PSP: personal and social performance scale, CGI-S: clinical global impression-severity, PANSS: positive and negative symptom scale, KDAI: Korean version of drug attitude inventory, KmSWN: Korean modification of the scale to measure subjective well-being under neuroleptic treatment, MSPSS: multidimensional scale of perceived social support

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