Mental and social function in chronic schizophrenia patients with heterogeneous clinical symptom profiles
Date Issued
2009
Date
2009
Author(s)
Chiang, Shih-Kuang
Abstract
Many studies showed schizophrenics were heterogeneous in their clinical symptoms and cognitive mental dysfunction features. In Taiwan, some researchers had studied on these pathological phenomena in outpatient or acute onset schizophrenia patients. However, for chronic inpatient schizophrenics, these pathological phenomena including clinical symptoms, mental dysfunction features, and social function are still unclear. It is necessary to do a comprehensive and serial studies understanding these pathological phenomena. In this dissertation, author designed eight serial studies for understanding mental dysfunction features and their relations to social function in chronic schizophrenics with heterogeneous clinical symptoms profiles. From Study 1 to study 4 are main studies. In study 3, author designed four preparatory studies. Their aims are as the following. 1. The aim of study 1 is for understanding symptom dimensions and their profiles in chronic schizophrenics. 2. The aim of study 2 is for understanding cognitive mental dysfunction features in chronic schizophrenics with different clinical symptom profiles. 3. The aim of study 3 is for understanding social mental dysfunction features in chronic schizophrenics with different clinical symptom profiles. For assessing social mental function, there are 4 preparatory studies which aims are as following. （1） The aim of preparatory study 1 is to testify the appropriateness of International Affective Picture System （IAPS） in adult sample of Taiwan. The IAPS is designed to assess subject’s emotion processing ability in social context. （2） The aim of preparatory study 2 is to compile and to revise the Taiwan version of International Reactivity Index （T-IRI） in adult sample of Taiwan. The T-IRI is designed to assess subject’s empathetic ability. （3） The aim of preparatory study 3 is to testify the appropriateness of Taiwan version of Apathy Evaluation Scale （T-AES） in chronic schizophrenics of Taiwan. The T-AES is designed to assess subject’s motive. （4） The aim of preparatory study 4 is to testify the appropriateness of Japanese and Caucasian Facial Expression of Emotion （JACFEE） in adult sample of Taiwan. The JACFEE is designed to assess subject’s facial recognition ability. 4. The aim of study 4 is for understanding influential factors on social function in chronic schizophrenics with different clinical symptom profiles. The results in study 1 showed there were 5 symptom dimensions in chronic schizophrenics. According these dimensions, chronic schizophrenics could be differentiated as 3 profiles including significant mixed positive and negative symptom, significant widespread symptom, and significant social withdrawal. Besides above results, study 1 found negative symptom in PANSS existing two mutually independent components. The results in study 2 showed there were heterogeneous in cognitive mental dysfunction features in chronic schizophrenics. According to these features, chronic schizophrenics could be differentiated as within normal cognitive range, executive function deficits, memory function deficits, executive with memory function deficits, and widespread cognitive deficits 5 subtypes. Meanwhile, study 2 had made up for Kremen, Seidman, Faraone, Toomey, and Tsuang（2004） study’s limitation. In addition, study 2 supported chronic schizophrenics exited impairments in multiple domains, especially in attention, memory and executive function. For significant widespread symptom group, processing speed and intellectual function also exited significant impairments. In study 3, preparatory study 1 testified the appropriateness of IAPS in adult sample of Taiwan, preparatory study 2 compiled and revised T-IRI in adult sample of Taiwan, preparatory study 3 testified the appropriateness of T-AES in chronic schizophrenics of Taiwan, preparatory study 4 testified the appropriateness of JACFEE in adult sample of Taiwan. Besides above results, preparatory study 4 found cultural factors and in-group advantage effect may influence judgment correct rate on fear and angry. In formal study, study 3 proved social mental function to have constructive and differential validity. Results showed chronic schizophrenics have deficits on their social mental function compared to normal control and these deficits may result from dysfunction on their frontal-temporal circuits. Other findings included apathy, empathetic concern and fear facial expression recognition probably having potential on early detection, and positive symptoms having negative influence on facial recognition. Finally, the results in study 4 showed there were different influential factors on social function and its subdimensions in chronic schizophrenics with different clinical symptom profiles. In addition, cognitive mental function, social mental function, clinical symptoms, and demographic variables have different weights on predictive power on social function of chronic schizophrenics. Overall, study 4 could be regarded as an empirical evidences to use neuropsychological assessment and cognitive rehabilitation as a psychosocial intervention approach in chronic schizophrenics in future.
Subjects
heterogeneous
chronic schizophrenics
symptom profiles
cognitive mental function
social mental function
social function
cognitive rehabilitation
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