Assessment of Functioning among Nigerians with Schizophrenia in a Tertiary Health Facility: Influence of Psychopathology, Socio-demographic and Treatment Factors

Abstract

To investigate the profile of functional impairment and the influence of psychopathology with other determinants among individuals with schizophrenia in a Nigerian tertiary health facility. The study participants consisted of one hundred adults with schizophrenia. Eligible participants were recruited using systematic random sampling technique. All participants were interviewed with questionnaire to elicit socio-demographic and treatment related information. This was followed by interview with brief psychiatric rating scale (BPRS) and the global assessment of functioning (GAF) to assess for psychopathology and impairment in functioning respectively. Analyses of data were done using SPSS-16. The mean age of the participants was 33.87(±11.6) years and a little above half (52 %) of the participants were female. Sixty (60 %) subjects had active psychopathology using BPRS cut-off score of >10; while participants with duration of illness of more than 10 years (X2 = 5.59, p = 0.018) and previous relapse (X2 = 6.34, p = 0.012) were more likely to have psychopathology. Overall, a little over two-thirds (69 %) had impairment following administration of GAF. Mild impairment was observed in 23 % of the participants, moderate impairment in 19 and up to 18 % of participants had severe impairment due to psychopathology. Subjects with lesser education, duration of illness of more than 10 years, extrapyramidal side effects (EPSE), previous relapse and psychopathology had significant levels of impairment (p < 0.05). However, it was education (Odds ratio [OR] = 0.060; 95 % Confidence interval [95 % CI] = 0.055, 0.770; p = 0.031), psychopathology (OR 5.265; 95 % CI 2.744, 13.626; p < 0.001) and EPSE (OR 0.183; 95 % CI 0.049, 0.939; p = 0.043) that were independently associated with impairment in functioning following logistic regression to control for effects of confounders. In this study, varied degrees of impairment in functioning were prevalent among individuals with schizophrenia under treatment. However, those with lesser education, EPSE, active psychopathology and longer duration of illness were more likely to be impaired. Thus, better attention to the management of active psychopathology and prevention of extra-pyramidal side effects are indicated in order to promote improve functioning in schizophrenia. In addition, promotion of recovery oriented psychosocial services with need-based rehabilitation program for individuals with schizophrenia is advocated. There is need for more research on predictors of functioning towards promotion of evidence based rehabilitation.