Social dysfunction and skills in schizophrenia: relationship with treatment response and severity of psychopathology

Scemes, Silvia; Savoia, Mariangela Gentil; Del Prette, Zilda; Mestriner, Paulo; Silva, Aline Roberta da; Elkis, Hélio

doi:10.1590/0101-60830000000095

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Archives of Clinical Psychiatry (São Paulo)

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Sumário

Original article • Arc. Clin. Psychiatr. 43 (5) • Sep-Oct 2016 • https://doi.org/10.1590/0101-60830000000095 copy

Social dysfunction and skills in schizophrenia: relationship with treatment response and severity of psychopathology

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Social dysfunction is an important outcome for schizophrenia and can be measured by the evaluation of social skills.

Objectives

To compare social skills in patients with schizophrenia classified according the degree of treatment response and severity of psychopathology with normative controls by using the Del Prette Social Skills Inventory (SSI).

Methods

Cross-sectional study where the 38 questions SSI was applied to 62 outpatients with schizophrenia and compared with data of 99 normal controls from the general population. The SSI was evaluated by five domains. Psychopathology was measured by the Positive and Negative Syndrome Scale (PANSS). Patients were classified as Treatment Resistant (TRS) and Non Treatment Resistant (NTRS) by the International Psychopharmacology Algorithm Project (IPAP) criteria. ANCOVA was used to control for demographic differences between populations.

Results

Patients showed significantly more impaired than controls except for aggressiveness control. When variables such as age, age of onset, schooling or medication dose entered as covariates, differences between controls and patients, or TRS with NTRS, almost disappeared. The SSI and PANSS showed an inverse relationship between their domains.

Discussion

The SSI may represent a useful tool for evaluation of social skills in schizophrenia. Antipsychotics may exert a protective effect on social skills.

Schizophrenia; social dysfunction; social skills; scales; social skills inventory

Domain	Name	Description
F1	Coping and self-assertion with risk	Evaluates assertiveness in interpersonal situations, to safeguard the rights of the individual and maintain self-esteem (e.g. ‘When a friend to whom I’ve lent some money forgets to give it back, I find a way to remind him/her’)
F2	Self-assertion in the expression of positive affect	Analyses self-confidence in the expression of positive feeling, the items depict the need for positive interpersonal feedback and affirmation of self-worth (e.g. ‘When someone does something I think is good, even if it is not directly related to me, I mention it, praising him/her at the first opportunity’)
F3	Conversation and social confidence	Evaluates conversational skill and social boldness, and its items portray neutral situations of initial social encounters (e.g. ‘When I am with a person who I have just met, it is difficult for me to keep an interesting conversation going’)
F4	Self-exposure to unknown people and new situations	Evaluate social openness to new people and new situations, describe situations that involve interacting with new people (e.g. ‘I avoid asking questions of people I don’t know’)
F5	Self-control of aggressiveness	Evaluate self-control of aggressiveness and individual reactions to aversive stimuli that require the management of anger and aggressiveness (e.g. ‘When my schoolmates or work colleagues tease me, I don’t let it bother me’)

Factors* of the SSI and demographic variables	Controls (n = 99)	Patients with schizophrenia (n = 62)	Statistical test	Significance (p value)
Age	31.62 (10.44)	40.29 (10.46)	t = -5.13	0.00
Gender	49 males; 50 females	24 males; 38 females	Chi-square = 2.14	0.14
Schooling (in years)	14.49 (2.48)	10.31 (2.37)	t = 10.61	0.00
F1	9.88 (2.93)	7.46 (3.29)	t = 4.86	0.00
F2	9.11 (1.72)	6.73 (2.80)	t = 6.02	0.00
F3	6.55 (2.17)	5.89 (1.83)	t = 2.01	0.05
F4	3.24 (1.27)	2.22 (1.49)	t = 4.62	0.00
F5	0.96 (0.70)	1.33 (0.69)	t = - 3.31	0.00

	Controls (N = 99)	TRS (N = 33)	Non TRS (N = 29)	Statistical Test	Significance (p)
Age (in years)	31.62 (10.44)	36.42 (7.71)	44.69 (11.97)	F = 19.00	0.00*
Gender	M = 49; F = 50	M = 24; F = 9	M = 14; F = 15	Chi-square = 5.85	0.05*
Schooling (in years)	14.49 (2.48)	10.52 (2.15)	10.07 (2.72)	F = 56.42	0.00*
Age of onset of illness (in years)	–	18.97 (4.99)	31.70 (15.09)	t = -4.20	0.00*
Duration of illness (in years)	–	17.45 (7.45)	13.52 (10.75)	t = 1.61	0.15
Antipsychotic medication (chlorpromazine equivalents) mg/day	–	1132.81 (309.9)	347.69 (194.7)	t = 11.75	0.00*
PANSS positive	–	12.47 (3.87)	9.50 (3.54)	t = 1.06	0.30
PANSS negative	–	27.50 (5.62)	16.50 (4.95)	t = 2.70	0.11
PANSS general	–	29.97 (6.88)	33.50 (6.36)	t = -0.71	0.49
PANSS total	–	69.94 (12.60)	59.50 (14.85)	t = 1.13	0.27

Factor*	Controls (N = 99)	TRS (N = 33)	NTRS (N = 29)	ANCOVA Model	Bonferroni pairwise comparisons
Factor*	Mean (SD)	Mean (SD)	Mean (SD)	F; p	Controls vs. TRS**	Controls vs. NTRS**	TRS vs NTRS**
F1	9.88 (2.93)	7.85 (3.33)	7.02 (3.24)	5.87; 0.00	0.09	0.02	1.00
F2	9.11 (1.72)	6.30 (3.10)	7.22 (2.38)	11.33; 0.00	0.00	0.00	1.00
F3	6.56 (2.17)	5.65 (2.09)	6.16 (1.47)	3.99; 0.00	0.00	0.11	0.81
F4	3.24 (1.27)	2.50 (1.41)	1.91 (1.54)	5.23; 0.00	0.09	0.01	0.59
F5	0.96 (0.70)	1.31 (0.59)	1.36 (0.79)	4.95; 0.00	1.00	0.73	1.00

Factor*	TRS (N = 33)	NTRS (N = 29)	ANCOVA Model	TRS vs NTRS Bonferroni Pairwise Comparison (p value)
	Mean (SD)	Mean (SD)	F; p
F1	7.90 (3.37)	7.09 (3.23)	0.84; 0.48	0.20
F2	6.40 (3.10)	7.16 (2.40)	0.71; 0.55	0.75
F3	5.70 (2.11)	6.21 (1.43)	0.75; 0.53	0.75
F4	2.50 (1.43)	1.81 (1.60)	0.97; 0.42	0.33
F5	1.32 (0.60)	1.36 (0.78)	0.22; 0.89	0.83

SSI Factors*	PANSS Positive	PANSS Negative	PANSS General Psychopathology
F1	-0.034; p = 0.85	-0.22; p = 0.22	-0,37; p = 0.03
F2	-0.03; p = 0.85	-1.94; p = 0.27	-0.15; p = 0.41
F3	-0.40; p = 0.02	0.02; p = 0.90	-0.36; p = 0.04
F4	-0.03; p = 0.90	-0.13; p = 0.47	-0.07; p = 0.72
F5	-0.19; p = 0.29	-0.09; p = 0.61	-0.01; p = 0.94

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[1] Address for correspondence: Hélio Elkis. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria. Rua Ovídio Pires de Campos, 785, Cerqueira César – 05403-010 – São Paulo, SP, Brazil. Telephone: +55 (11) 2661-7531. E-mail: helkis@usp.br.