PSYCHOSOCIAL FUNCTIONING IN SCHIZOPHRENIC -PATIENTS - A 30-MONTH COMMUNITARY FOLLOW-UP

Ever since the introduction of neuroleptic medication and tile initiat ion of the deinstitutionalization process, which unfortunately has not been adequately accomplished, a new goal was established for patients suffering from schizophrenia; that is, their return to lead a stable life to the community. The system to treat these patients not only inc ludes the therapeutic implications, but also the treatment outcome; as a result, follow-up studies have been taken into consideration and ha ve become very important because the possibility evaluate of the patie nt's functioning on the community. It has also been established that p ersons with schizophrenia suffer from several difficulties known as ps ychosocial impairments that interfere with their ability to organize a n unassisted and stable adjustment to community life. Psychosocial fun ctioning refers to the evaluation of the patient's psychosocial impair ments or difficulties in role performance that interfere with a satisf actory community functioning. Schizophrenic patients usually have diff iculties in several areas of functioning. Most of the time they are un able to maintain a steady job (occupational area). Therefore, they do not have economic resources for leading an independent life in the com munity (economic or money management area). Social contacts are very l imited and they lack a social support network (social area) Most patie nts are single and generally they do not have meaningful or close rela tionships (marital and non-marital area). Finally, family life might e xert a significant influence on the course of schizophrenia (for insta nce, the risk of relapse) and also in the patient's psychosocial funct ioning. The purpose of this article is to report the results of a 30 m onths community follow-up study of schizophrenic patients using the Ps ychosocial Functioning Scale. Demographic characteristics, living cond itions and psychosocial functioning at 6,18 and 30 months are reported . Variables such as the use of neuroleptic medication and rehospitaliz acion are analyzed. The Psychosocial Functioning Scale (PSFS) develope d at The Mexican Institute of Psychiatry was administered for the asse ssment of the patient's psychosocial functioning through an interview at the patient's home by a team of research psychologists and social w orkers. The PSFS includes information about sociodemographic character istics, living conditions and family organization. It contains 35 item s that cover five major areas of role performance: 1) occupational, 2) social relations, 3) economic or money management, 4) marital and non -marital sexual roles, 5) family relations as well as global psychosoc ial functioning. Ratings are made on a five-point scale that indicates the level of satisfaction: If very satisfied, 2) satisfied, 3) neutra l-indiferent, 4) unsatisfied, 5) very unsatisfied, reported by the pat ients at follow-up, The PSFS is a semistructured interview that is adm inistered to the patient by a trained interviewer. The Scale is estima ted to take about 30 minutes to complete. Validity and reliability had been previously established for the PSFS. A varimax factor analysis w as applied and five factors (the five areas of the scale) emerged for the construct validity. This accounted for 52 percent of the total var iance. Reliability coefficients for all areas were over .83 (p = 0.01) : occupational = .83, social = .84, economic = .88, sexual = .96 and f amiliar = .83. Subjects included in the present study were 31 schizoph renic patients discharged after a four week hospitalization period fro m a psychiatric hospital for acute patients, All patients had a clinic al diagnosis of schizophrenia at admission; the diagnosis was confirme d on the basis of the DSM-III-R while the patients were still at the h ospital, and also at discharge. Patients with a diagnosis of schizophr eniform or schizoaffective disorder were not included in the sample. S ubjects included in the present study also had to meet the following c riteria: more than 18 years of age, male or female, residents of Mexic o City and the metropolitan area. The results showed that 74.2 % of th e patients were male and 25.8 % were female, with a mean age of 33 yea rs, 74 % were single and 39 % of the sample had college education, 42 % were unemployed, 29 % performed some housework duties and 29 % were students and house wives. Psychosocial functioning was reported by the patients as satisfactory (level 2) at 6, 18 and 30 months follow-up i n the following areas: occupational, social relations, marital and non marital sexual roles and family relations and also in the global psych osocial functioning. In the economic or money management area, patient s reported role performance as neutral or indifferent (level 3) at 30 months follow-up. Statistically significant differences were observed in the occupational area (p = .03) and social relations (p = .03) when comparing functioning in this areas al 6 and 30 months follow-up. It is worth mentioning that the most stable area of functioning was in fa mily relations: (x) over bar = 2.5 at 6 months; (x) over bar = 2.6 at 18 months and (x) over bar = 2.5 at 30 months follow-up. A decrease wa s also observed in the levels of satisfaction in global psychosocial f unctioning at 6 months ((x) over bar = 2.5); at 18 months ((x) over ba r = 2.6) and at 30 months ((x) over bar = 2.8). The patients also repo rted problems in the use of neuroleptic medication since its use decre ased from 74 % at 6 months to 61 % at 18 months and to 51 % at 30 mont hs follow-up, This indicates noncompliance with medication in 50 % of the patients, 30 months after being discharged from the hospital. Psyc hosocial functioning levels were compared in patients with medication and patients with no medication. in patients with medication, statisti cally significant differences were observed in the marital and non-mar ital sexual area (p = .03) at 6 and 18 months, in the occupational are a (p = .03), in social relations (p = .03) in marital and non-marital sexual area (p = .04) at 18 and 30 months and in the occupational area (p = .04), and social relations (p = .03) at 6 and 30 months. In pati ents with no medication, statistically significant differences were no t observed in neither of the five areas of assessment nor in global ps ychosocial functioning throughout the 30 months follow-up. Similar res ults were observed in rehospitalized patients. On the other hand, stat istically significant differences were found in patients wit