|Year : 2013 | Volume
| Issue : 1 | Page : 65-68
Current social functioning in adult-onset schizophrenia and its relation with positive symptoms
Partha S Kundu1, Vinod K Sinha2, Sarita E Paul3, Pushpal Desarkar4
1 Psychiatrist, West Bengal Health Service, Govt. of West Bengal, Kolkata, West Bengal, India
2 Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
3 Montfordshire Partnership, NHS Foundation Trust, London, United Kingdom
4 Centre for Addiction and Mental Health, Toronto, ON, Canada
|Date of Web Publication||24-Dec-2013|
Partha S Kundu
Psychiatrist, West Bengal Health Service, Govt. of West Bengal, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: In schizophrenia, relation exists between psychopathology and social functioning. Aim and Objectives: Determining relationship of positive symptoms with current social functioning in adult-onset (≥19 years) schizophrenia. Materials and Methods: Eighty schizophrenia patients [ICD-10-DCR], of both sexes (18-60 years), on follow-up for ≥6 months, with no change of diagnosis and without co-morbidities, having onset of illness ≥19 years of age, accompanied by informants having contact with the patient for a period of >12 months prior the first psychiatric contact or symptom onset were assessed with SCARF- Social Functioning Index and SAPS. Results: Family role, occupational role, and other social role have negative correlation with all positive symptoms. Conclusion: Current social functioning has significant negative correlation with concurrent positive symptoms.
Keywords: Positive symptoms, psychopathology, schizophrenia, social functioning
|How to cite this article:|
Kundu PS, Sinha VK, Paul SE, Desarkar P. Current social functioning in adult-onset schizophrenia and its relation with positive symptoms. Ind Psychiatry J 2013;22:65-8
Over the years, clinicians and researchers in schizophrenia have posited that symptoms and social functioning are intertwined.  Assessing social functioning is critical importance in schizophrenia as it faithfully reflects patients' clinical condition, has been found to be inversely associated with nearly all indices of illness severity, deteriorates when symptoms intensify, improves with betterment of clinical situation and also linked with poorer prognoses and higher risks for symptom relapse. ,, Schizophrenia is a heterogeneous disorder, and schizophrenia with onset during various age of life is distinctly different from each other with childhood and adolescent onset schizophrenia having particularly deleterious effect on symptomatology and social functioning, and adult and late life onset ones having relatively better prognosis.  Here, this study has tried to determine relationship of positive symptoms with current social functioning in adult-onset (≥19 years) schizophrenia.
| Materials and Methods|| |
Inclusion criteria for the patients
Male and female subjects from 18 to 60 years of age, diagnosed with schizophrenia, fulfilling ICD-10-DCR criteria who is having their age of onset of illness at ≥19 years of age. Patient should be accompanied by guardians who have at least 5 years of formal education and who have been in contact with the patient for at least a period of more than 12 months before the first psychiatric hospital admission or contact with a psychiatrist or before evidence of characteristic florid psychotic symptomatology. Patient should be on a regular follow up for at least a period of 6 months with no subsequent change in diagnosis or addition of any co-morbid other psychiatric diagnosis. Patient/guardian should give informed consent.
Exclusion criteria for the patients
Co-morbid serious medical illnesses, mental retardation and other psychiatric diagnosis including substance dependence (except nicotine and caffeine) and personality disorders.
- Socio-demographic and Clinical Data Sheet.
- Social Functioning Index of Schizophrenia Research Foundation (SCARF) - India. 
- Scale for Assessment of Positive Symptoms (SAPS) 
Adult male and female patients who come along with their guardians and meeting the inclusion and exclusion criteria were taken up for the study. Informed consent was taken from the guardians and/or the patients. A detailed interview to fill the socio-demographic and clinical datasheet was initially undertaken with each patient and the accompanying guardian. His/Her current social functioning was rated on SCARF- India's social functioning index, and positive symptoms were rated on using Scale for Assessment of Positive Symptoms (SAPS). The data collected were statistically analyzed using Statistical Package for Social Sciences (SPSS) 10.1 for Windows 98. Frequency analysis was done as part of descriptive statistics, to describe the sample in terms of socio-demographic and clinical characteristics.
| Results|| |
Demographic and clinical characteristics of the sample (N = 80) are given in [Table 1]. [Table 2] shows significant negative (P < 0.01) correlation of SCARF-SFI total score with total scores of SAPS in adult-onset (≥19 years) schizophrenia. [Table 3] shows that the occupational role domain of SCARF-SFI is significantly negatively correlated (P < 0.05) with hallucination. The family role domain of SCARF-SFI is significantly negatively correlated (P < 0.05) with delusion and bizarre behavior subscale of SAPS. The other social role of SCARF-SFI has significant negative correlation with bizarre behavior subscale of SAPS (P < 0.05) in adult-onset (≥19 years) schizophrenia.
|Table 2: Correlation (Pearson's r) of SCARF‑SFI total score with SAPS total scores in adult‑onset (≥19 years) schizophrenia (N=80)|
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|Table 3: Correlation between components of SCARF‑SFI and SAPS in adult‑onset (≥19 years) schizophrenia (N=80)|
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| Discussion|| |
In this study, patients who after being diagnosed as having schizophrenia according to ICD-10-DCR criterion must be on a regular follow up for at least a period of 6 months with no subsequent change in diagnosis or inclusion of any co-morbid diagnosis. This stringent inclusion criterion implies diagnostic stability and lesser chance of contamination by other diagnostic groups, which was a pitfall of many earlier studies. Only those patients were included, who were accompanied by guardians having at least 5 years of formal education. Information can be better obtained from such informants, as all of them had received formal education at least up to primary school level. To assess social functioning in this study, SCARF-India's Social Functioning Index (SCARF-SFI) was used. Earlier studies in India have used scales like World Health Organization - Disability Assessment Schedule (WHO-DAS) to assess social functioning. SCARF-SFI is a distinct improvement upon those scales as it is standardized and tested for the Indian population and found to have good internal consistency, inter-rater reliability, and validity. This instrument also covers the conceptual areas of social functioning as recommended by Weissman et al. 
To assess positive symptoms, Scale for Assessment of Positive Symptoms (SAPS) was used instead of using relatively non-specific scales like Positive and Negative Symptom Scale (PANSS), which helped in assessing pure positive symptoms much more effectively. In adult-onset (≥19 years) schizophrenia subgroup (N = 80), a significant negative correlation (P < 0.01) of SCARF-SFI total score with total scores of SAPS was found. It was also evaluated which domains of social functioning are affected by various faculties of positive symptoms as enumerated in SAPS. A fine-grained analysis of the relationship between domains of social functioning as delineated in SCARF-SFI and domains of SAPS found that occupational role was significantly negatively correlated with hallucination (P < 0.05). The family role had significant negative correlation with delusion and bizarre behavior (P < 0.05), whereas the other social role was significantly negatively affected by bizarre behavior only (P < 0.05). This finding was fully corroborative with the earlier studies. , Analyzing the results in a holistic way, it could be observed that in the adult-onset (≥19 years) subgroup, positive symptoms had significant impact on current social functioning.
Practical implications of these findings of the current study are manifold. Schizophrenia is a leading worldwide public health problem that exacts enormous personal and economic costs. Positive symptoms have been detected to be the major contributor of socio-occupational dysfunction in them. Adequate recognition and implementations of appropriate interventions may help in amelioration of one of the biggest disabilities of world. The positive symptoms could be managed with pharmacological and/or psychosocial interventions like cognitive behavioral therapy to help this patients lead a more fruitful life.
- The study was conducted in a tertiary care hospital setting where mainly assessment of severely ill patients is done. So, there is a chance of bias in the selection.
- Sample of current study has a male: female ratio of about 4:1, thereby limiting statistical power of tests in case of females. So, the conclusions derived from the study might not hold good for schizophrenic patients of both the sexes.
- The cross-sectional study design in the present study fails to point out any changes on the level of positive symptoms over the course of time. The changes could have been due to ongoing treatment, hospitalization, and several other factors. No association between anti-psychotic dosage and positive symptoms has been looked for. Also, effects of different types of medications (e.g. typical and atypical) on positive symptoms of schizophrenia and concurrent social functioning could not be tested.
- In present study, biological correlates of pre-morbid and current social functioning or concurrent schizophrenic symptoms have not been looked for. Any significant finding in this respect would have been enlightening.
- While assessing social functioning in schizophrenia, present study lacked measures of numerous relevant clinical and environmental factors like information processing deficit, self-stigma, work, and residential environments, which would have been helpful in measuring social functioning.
- As the study sample was recruited from a tertiary referral center, replication is required in a population-based sample with larger sample size drawn in a randomized fashion.
- Studies should incorporate the effect of medication on level of positive symptoms, and concurrent social functioning in schizophrenia may come out with interesting findings, which would have implications in treatment.
- Studies looking for biological correlates of pre-morbid and current social functioning in schizophrenia or concurrent schizophrenic symptoms would give a new light on the neurobiology of this disease. These studies may include advanced neuroimaging techniques (e.g. C.T. scan, M.R.I., f M.R.I etc.), neurophysiological investigations (e.g. EEG, ERP etc.) or evaluate biochemical parameters in blood or CSF in individuals with schizophrenia.
- Future studies on social functioning should incorporate a wide array of social network indicators and measures of work and residential environment.
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[Table 1], [Table 2], [Table 3]