Predictori ai evoluţiei clinice a schizofreniei

Abstract

Introduction. Schizophrenia is a serious disorder that influences all aspects of the patients’ life. The most important goals in schizophrenia are remission, recovery, and improving psychosocial functioning and quality of life. Unfortunately, there are important barriers to achieving optimal long-term outcomes in this disease due to patient-related factors and treatment-related factors. Lack of insight is considered the main reason for partial/non-adherence and, therefore, for the long-term outcome.  Aim. The aim of this study was to identify the predictive factors involved in long-term schizophrenia, and especially the role of the awareness of illness.  Materials and method. Eighty patients (44 males and 36 females) recruited from the First and Second Psychiatric Clinic from Cluj-Napoca, diagnosed according to ICD-10 criteria with schizophrenia, participated in this study. A semi-structured interview collected the demographical data. Psychotic symptoms were evaluated using Positive and Negative Syndrome Scale (PANSS), severity of the disease using Clinical Global Impression (CGI) and insight using the Scale for the Assessment of Unawareness of Mental Disorder (SUMD), the Schedule for Assessment of Insight-Expanded version (SAI-E) and Beck Cognitive Insight Scale (BCIS).  Results. Our results showed that, among potential predictors of psychotic symptoms change measured in this research, those significantly correlated with changes are the level of insight measured with SUMD scale (r=-0.41; p<0.01), presence of family history (r=0.24; p<0.05), and belonging to urban areas (r=0.23; p<0.05). The level of insight, as one predictor, with PANSS initially controlled, explained 16% of variance of improving psychotic symptoms during hospitalization. Also, patients from urban areas seem to have a slight tendency towards higher magnitudes of the changes (low correlation, but statistically significant). Again, the square of the correlation obtained (coefficient of determination) indicates that urban membership explaines 5% of variance when symptoms improve. Also, it seems that the family history is positively associated with the magnitude of symptoms’ change, but the level of this relationship is also reduced.  Conclusions. The awareness of illness is one of the predictive factors for long-term schizophrenia, and the best predictive model of disease progression is composed of variables SUMD total and PANSS total on admission.