How do we measure the functional outcomes in schizophrenia? (European Psychiatry, Aug 2012)


Many patents with symptomatic recovery do not achieve functional recovery. Symptomatic and functional remission appear to be different domains, representing two steps towards recovery that can but do not necessarily overlap.   Measuring functional outcome is difficult ( what is “appropriate” for this patient?)  and no consensus exists on the ideal tool.The European Group On Functional Outcomes and Remission in Schizophrenia [EGOFORS]), met to discuss these challenges  and the above article is a summary of that.

There is more interest in functional outcome.Treatment success is better defined by this than symptomatic recovery. A review described 20 different scales for functional outcomes (only scales used in three or more trials were documented). Within these scales, a total of 87 different measures were assessed. The five most commonly used scales identified in the literature were: the Global Assessment of Functioning (GAF), Global Assessment Scale (GAS), Social Functioning Scale (SFS)  and Social and Occupational Functioning Assessment Scale (SOFAS).Many tools are on its way.Functional Remission of General Schizophrenia (FROGS) Scale is a French initiative which aims to develop a schizophrenia-specific tool to measure functioning.This is a 19-item scale based around five domains (daily life, social activities, social functioning, quality of rehabilitation and general health and treatment).

Psychosocial Remission in Schizophrenia Scale (PSRS) from Isreal has been developed in Israel  and  includes  eight items. (familial relations, understanding and self-awareness, energy, interest in daily life, self-care, activism, responsibility for medical treatment and use of community services). The University of California Performance-based Skills Assessment-B (UPSA-B) is a performance-based measure of functional capacity that has been developed for severely mentally ill patients.The UPSA-B differs from some other tools to evaluate functioning in that it involves quite specific role-play situation.The self-rating Subjective Wellbeing under Neuroleptic treatment (SWN) Scale has been developed to measure subjective well-being in schizophrenia patients.  Quality of Life Scale (QLS) is another scale which although evaluating quality of life also provides information on symptoms and functioning  .

Main challenges:

1. There are many scales with correlation between them unknown.

2. There is considerable variation in the number and type of domains covered by each scale.

3. It is unclear which approach to evaluation (clinician or self-report) is most beneficial for the evaluation of function

4. There is also considerable variety in the time required to carry out functional assessments

5.Different scales might provide different information regarding functioning and thus have different utility at different stages of the disease.

Group’s conclusions:    A useful tool would be one that was able to evaluate a meaningful improvement of functioning and that could be employed in clinical trials with relative ease. To encourage evaluation of functioning outside clinical trials, any tool should also be relatively simple and quick to use.  Further exploration of the correlation between existing functional assessments is essential.

EGOFORS initiative is one of the first to investigate any correlation between functional scales in addition to documenting the ease, quality and relevance of each tool used, and may ultimately determine whether correlation can be improved by selecting specific domains.

Summary of article:

How are we assessing functioning in schizophrenia? A need for a consensus approach.

Peuskens J, Gorwood P; EGOFORS Initiative. Eur Psychiatry. 2012 Aug;27(6):391-5

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