Abstract
Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%–30% within 1–2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ2(1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31–0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.
Highlights
Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently
We identified a four-factor structure of social cognitive bias, reflective self, neurocognition, and prereflective self in ultra-high risk (UHR), recent-onset schizophrenia (ROSPR), and healthy controls (HCs) individuals
There were overall group differences in these four factors between the UHR, ROSPR, and HC groups. These factors were found to be associated with baseline psychosocial function in the UHR and ROSPR groups as well as with conversion rate in the UHR group during follow-up
Summary
Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Frequent readmission to healthcare institutions affects social functioning and the quality of life of patients with schizophrenia. Understanding the factors associated with impaired social functioning and readmission to a healthcare institution may be crucial to help patients with schizophrenia achieve better quality of life. Neurocognitive impairment is related to a decline in social functioning, and verbal memory [2], spatial organization [3], visual memory, and intelligence quotient [4] have been suggested to correlate with social and vocational outcome in patients with schizophrenia [5]. Previous longitudinal studies suggested that basic symptoms have a negative relationship with social functioning and quality of life in patients with schizophrenia [14] and that schizotypy predicts social functional impairment [15]. We analyzed the factor structure of self-related variables and neuroand socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis
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