The Puzzle of Functional Recovery in Schizophrenia-Spectrum Disorders—Replicating a Network Analysis Study

Abstract

Background and hypothesis Recovery from psychosis is a complex phenomenon determined by an array of variables mutually impacting each other in a manner that is not fully understood. The aim of this study is to perform an approximated replication of a previous network analysis study investigating how different clinical aspects—covering psychopathology, cognition, personal resources, functional capacity, and real-life functioning—are interrelated in the context of schizophrenia-spectrum disorders. Study design A sample of 843 subjects from a multisite cohort study, with the diagnosis of a schizophrenia-spectrum disorder, was used to estimate a network comprising 27 variables. The connectivity and relative importance of the variables was examined through network analysis. We used a quantitative and qualitative approach to infer replication quality. Study results Functional capacity and real-life functioning were central and bridged different domains of the network, in line with the replicated study. Neurocognition, interpersonal relationships, and avolition were also key elements of the network, in close relation to aspects of functioning. Despite significant methodological differences, the current study could substantially replicate previous findings. Conclusions Results solidify the network analysis approach in the context of mental disorders and further inform future studies about key variables in the context of recovery from psychotic disorders.

What factors should we modify to promote high functioning and prevent functional decline in people with schizophrenia?

“…Furthermore, some authors suggest specific relationship patterns. While experiential symptoms (avolition, anhedonia, and asociality) negatively impact work, global functioning, and interpersonal relationships (10)(11)(12)(13), expressive symptoms (affective flattening and alogia) mainly impact social functioning (14)(15)(16).…”

Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects

“…Schizophrenia is a severe mental illness (SMI) affecting more than 21 million people worldwide that frequently leads to a persistent disability and impaired cognitive, social, and emotional functioning [ 1 ]. Schizophrenia is currently conceptualized as being characterized by at least positive symptoms (such as delusions and hallucinations), negative symptoms (including anhedonia, alogia, avolition, and social withdrawal), and cognitive symptoms (such as deficits in attention, processing speed, verbal learning, visuospatial learning, problem solving, working memory, and cognitive flexibility) [ 2 , 3 , 4 , 5 ]. Moreover, social cognition (including emotional intelligence, facial emotion recognition, emotion evaluation, and social inference) impairment may significantly impact the functional recovery in schizophrenia patients, due to the negative effects on interpersonal relationships, community adjustment, and vocational functioning [ 6 , 7 ].…”

Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature

“…The relationships among these variables and functional outcome seem to be very complex and to follow multiple and complicated pathways ( 5 , 16 , 26 , 27 , 37 ). For instance, it has been found that neurocognition influences the functional outcome, in particular the areas of everyday and work skills, mainly indirectly through functional capacity, social cognition, engagement with services, and internalized stigma, which in turn is indirectly associated with the functional outcome through the resilience ( 16 , 27 ).…”

“…Furthermore, it has been found, by using network analyses, that functional capacity and everyday life skills emerge as the most central and interconnected nodes ( 5 , 26 , 37 ). Functional capacity is the bridge between cognition (neurocognition and social cognition) and functional outcome ( 5 , 26 , 37 ), in particular the area of everyday life skills which, in its turn, connects other domains of functional outcome with psychopathology and internalized stigma ( 5 , 26 ).…”

“…Furthermore, it has been found, by using network analyses, that functional capacity and everyday life skills emerge as the most central and interconnected nodes ( 5 , 26 , 37 ). Functional capacity is the bridge between cognition (neurocognition and social cognition) and functional outcome ( 5 , 26 , 37 ), in particular the area of everyday life skills which, in its turn, connects other domains of functional outcome with psychopathology and internalized stigma ( 5 , 26 ). The two domains of negative symptoms (the Experiential domain and the Expressive one) have different associations with functional outcome: the former one, defined above, with interpersonal relationships and work skills, while the latter domain, consisting of blunted affect and alogia, is connected with everyday life skills ( 5 , 26 , 37 ).…”