Instrumental Activities of Daily Living Dysfunction among People with Schizophrenia

By Samuel, Reema; Thomas, Elizabeth et al. | Indian Journal of Psychological Medicine, March-April 2018 | Go to article overview

Instrumental Activities of Daily Living Dysfunction among People with Schizophrenia


Samuel, Reema, Thomas, Elizabeth, Jacob, K., Indian Journal of Psychological Medicine


Byline: Reema. Samuel, Elizabeth. Thomas, K. Jacob

Background: Life skills are the basic skills that are needed to live independently and that support meaningful, productive roles. The negative symptoms and cognitive dysfunction seen in schizophrenia may lead to deterioration in the life skills of the patient. The assessment of current life skills of the patient and subsequent intervention becomes necessary for comprehensive rehabilitation of people with mental illness. This study attempted to assess the instrumental activities of daily living among people with schizophrenia in India. Methods: One hundred consecutive patients with schizophrenia, between 18 and 60 years, who presented to a tertiary psychiatric facility were assessed using (i) Lawton instrumental activities of daily living scale (LIADL), (ii) positive and negative symptom scale (PANSS), (iii) pro forma for sociodemographic and clinical characteristics. Results: The majority of the patients were male, young adults, married, with secondary school education, middle socioeconomic status, from nuclear families, unemployed and were diagnosed to have paranoid schizophrenia. The reported IADL dysfunction included difficulties in handling medications (86%), preparing food (85%), shopping (78%), handling finances (61%), doing laundry (52%), housekeeping (47%), using public transport (32%), and using telephones (5%). The dysfunction documented differs from that reported in the west. Total PANSS score (P = 0.015) and its general psychopathology subscale (P = 0.005) correlated inversely with the total LIADL score; PANSS scores and sociodemographic variables were associated with some subscales of LIADL. Conclusions: IADL dysfunction, common in people with schizophrenia, demands detailed assessment, and tailored training to ensure optimum functioning.

Introduction

Despite 50 years of pharmacological and psychosocial intervention, schizophrenia remains one of the leading causes of disability in the world. The syndrome is associated with functional impairments in social, occupational, and independent living activities.[1] It has been argued that one of the primary reasons for the historical lack of improvement in functional outcome is a general lack of success in treating the aspects of schizophrenia such as cognitive impairment and negative symptoms as these have the strongest associations with functional recovery.[2]

In India, self-care is a common unmet need for people with psychiatric disorders as the psychiatric care mostly involves addressing the acute symptoms with little emphasis on rehabilitation.[3] There is dearth of studies from India which have documented deficits in instrumental activities of daily living skills. This study attempted to examine the extent of dysfunction in these life skills in people with schizophrenia.

Methods

Study setting

The study was done in a 122-bed tertiary referral center having both inpatient and outpatient facilities for adults and children with mental and behavioral disorders. The center cares for patients with a variety of mental illnesses including schizophrenia. Psychiatrists, psychiatric nurses, occupational therapists, clinical psychologists, and psychiatric social workers form the treatment team and employ a multidisciplinary approach to the care of patients with mental illness. Pharmacological treatments, electroconvulsive therapy, and different psychological therapies are used in an eclectic approach. Patients who require comprehensive rehabilitation are admitted for an average of 4-6 weeks. They attend the occupational therapy unit where psychosocial rehabilitation is provided through one to one as well as group-based interventions.

Study sample

100 consecutive persons diagnosed to have schizophrenia by the International Classification of Disease 10 criteria,[4] aged from 18 to 60, attending the occupational therapy unit of the department were recruited for the study after obtaining written informed consent. …

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