205
Views
0
CrossRef citations to date
0
Altmetric
REVIEW

Cerebral, Psychosocial, Family Functioning and Disability of Persons with Schizophrenia

, , &
Pages 2069-2082 | Received 12 Apr 2022, Accepted 30 Jul 2022, Published online: 15 Sep 2022

References

  • Herculano-Houzel S. The human brain in numbers: a linearly scaled-up primate brain. Front Hum Neurosci. 2009;3(31):1–11. doi:10.3389/neuro.09.031.2009
  • von Bartheld CS, Bahney J, Herculano-Houzel S. The search for true numbers of neurons and glial cells in the human brain: a review of 150 years of cell counting. J Comp Neurol. 2016;524(18):3865–3895. doi:10.1002/cne.24040
  • Helfrich RF, Fiebelkorn IC, Szczepanski SM, et al. Neural mechanisms of sustained attention are rhythmic. Neuron. 2018;99(4):854–865. doi:10.1016/j.neuron.2018.07.032
  • Berlucchi G, Vallar G. The history of the neurophysiology and neurology of the parietal lobe. Handb Clin Neurol. 2018;151:3–30.
  • Stiles J, Jernigan TL. The basics of brain development. Neuropsychol Rev. 2010;20(4):327–348. doi:10.1007/s11065-010-9148-4
  • Kandel E. La Era Del Inconsciente: La Exploración Del Inconsciente En El Arte, la Mente y El Cerebro. Barcelona: Ediciones Paidós; 2013. Spanish.
  • Insel TR. Rethinking schizophrenia. Nature. 2010;468(7321):187–193. doi:10.1038/nature09552
  • Rajasekaran A, Venkatasubramanian G, Berk M, et al. Mitochondrial dysfunction in schizophrenia: pathways, mechanisms and implications. Neurosci Biobehav Rev. 2015;48:10–21. doi:10.1016/j.neubiorev.2014.11.005
  • Stahl SM. Beyond the dopamine hypothesis of schizophrenia to three neural networks of psychosis: dopamine, serotonin, and glutamate. CNS Spectr. 2018;23(3):187–191. doi:10.1017/S1092852918001013
  • Ross CA, Margolis RL, Reading SA, et al. Neurobiology of schizophrenia. Neuron. 2006;52(1):139–153. doi:10.1016/j.neuron.2006.09.015
  • Plum F. Prospects for research on schizophrenia. Neuropathological findings. Neurosci Res Prog Bull. 1972;10:384–388.
  • Thompson PM, Stein JL, Medland SE, et al. The ENIGMA Consortium: large-scale collaborative analyses of neuroimaging and genetic data. Brain Imaging Behav. 2014;8(2):153–182. doi:10.1007/s11682-013-9269-5
  • Zhuo C, Hou W, Li G, et al. The genomics of schizophrenia: shortcomings and solutions. Prog Neuropsychopharmacol Biol Psychiatry. 2019;93:71–76. doi:10.1016/j.pnpbp.2019.03.009
  • Kotlar AV, Mercer KB, Zwick ME, et al. New discoveries in schizophrenia genetics reveal neurobiological pathways: a review of recent findings. Eur J Med Genet. 2015;58(12):704–714. doi:10.1016/j.ejmg.2015.10.008
  • American Psychiatric Association (APA). Diagnostic and Statistical Manual for Mental Disorders. 4th ed. Washington, DC: APA; 1994.
  • Asociación Estadounidense de Psiquiatría (APA). Manual Estadístico de los Trastornos Mentales V. [DSM-5. Diagnostic and Statistical Manual of Mental Disorders]. Arlington, VA: Editorial Médica Panamericana; 2013. Spanish.
  • Neiman LJ, Hugues JW. The problem of the concept of role. A resurvey of the literature. Soc Forces. 1954;30:141–149. doi:10.2307/2571625
  • Videbeck R. Dynamic properties of the concept role. Midwest Soc. 1958;20(2):104–108.
  • Gurland BJ, Yorkston NJ, Stone AR, et al. The Structured and Scaled Interview to Assess Maladjustment (SSIAM)I. Description, rationale, and development. Arch Gen Psychiatry. 1972;27(2):259–264. doi:10.1001/archpsyc.1972.01750260101017
  • Jablensky A, Schwarz R, Tomov T. WHO collaborative study on impairments and disabilities associated with schizophrenic disorders. A preliminary communication: objectives and methods. Acta Psychiatr Scand. 1980;62:152–163. doi:10.1111/j.1600-0447.1980.tb07687.x
  • Platt S. Social adjustment as a criterion of treatment success: just what are we measuring ? Psychiatry. 1981;44:95–112. doi:10.1080/00332747.1981.11024096
  • Weissman M, Sholomskas D, John K. The assessment of social adjustment. An update. Archiv Gen Psychiatry. 1981;38:1250–1258. doi:10.1001/archpsyc.1981.01780360066006
  • Endicott J, Spitzer RL, Fleiss JL, et al. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976;33(6):766–771. doi:10.1001/archpsyc.1976.01770060086012
  • Valencia M, Rascón ML, Juárez F, et al. A psychosocial skills training approach in Mexican out-patients with schizophrenia. Psychol Med. 2007;37:1393–1402. doi:10.1017/S0033291707000657
  • Aas IHM. Global Assessment of Functioning (GAF): properties and frontier of current knowledge. Ann Gen Psychiatry. 2010;9:20. doi:10.1186/1744-859X-9-20
  • Aas IHM. Towards a better Global Assessment of Functioning (GAF): improving scale properties. Int J Emerg Ment Health. 2014;17(1):197–202.
  • Brissos S, Molodynski A, Figueira ML. The importance of measuring psychosocial functioning in schizophrenia. Ann Gen Psychiatry. 2011;10(1):18–25. doi:10.1186/1744-859X-10-18
  • Stefanopoulou E, Lafuente AR, Fonseca AS. Global assessment of psychosocial functioning and predictors of outcome in schizophrenia. Int J Psychiatry Clin Pract. 2011;15(1):62–68. doi:10.3109/13651501.2010.519035
  • Figueira ML, Brissos S. Measuring psychosocial outcomes in schizophrenia patients. Curr Opin Psychiatry. 2011;24:91–99. doi:10.1097/YCO.0b013e3283438119
  • Gorwood P. Psychosocial functioning (PSF)- definition and measurement. Eur Psychiatry. 2012;27:1. doi:10.1016/S0924-9338(12)75679-1
  • Suttajit S, Suwanna A, Srisurapanont L, et al. Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains? Neuropsychiatr Dis Treat. 2015;11:2471–2477. doi:10.2147/NDT.S88085
  • Sarbin T, Allen V. Role Theory. The Handbook of Social Psychology. 2nd ed. Gardner L, Aronson E, Eds. Addison-Wesley Publishing, California; 1968:488–567.
  • Clare AW, Cairns VE. Designs development and the use of a standardized interview to assess maladjustment and dysfunction in the community studies. Psychol Med. 1978;8:589–604. doi:10.1017/S0033291700018808
  • Mueser K, Tarrier N. Handbook of Social Functioning in Schizophrenia. Boston, MA: Alland&Bacon; 1998.
  • Valencia M, Rojas E, González C, Ramos L. Evaluación del funcionamiento psicosocial en pacientes de un centro de salud. Revista Salud Pública de México. 1989;31(5):674–687. Spanish.
  • Casas E, Escandell MJ, Ribas M, et al. Instrumentos de evaluación en rehabilitación psicosocial. [Assessment in psychosocial rehabilitation]. Revista de la Asociación Española de Neuropsiquiatría. 2010;105:25–47. Spanish.
  • Brissos S, Dias VV, Balanza-Martinez V, et al. Symptomatic remission in schizophrenia patients: relationship with social functioning, quality of life, and neurocognitive performance. Schizophr Res. 2011;129(2–3):133–136. doi:10.1016/j.schres.2011.04.001
  • Green MF, Kern RS. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophrenia Bull. 2000;26(1):119–136. doi:10.1093/oxfordjournals.schbul.a033430
  • Bellack A, Green M, Cook JA, et al. Assessment of community functioning in people with schizophrenia and other severe mental illnesses: a white paper based on an NIMH-sponsored workshop. Schiz Bull. 2007;33(3):805–822. doi:10.1093/schbul/sbl035
  • Gorwood P, Burns T, Juckel G, et al. Psychiatrists’ perceptions of the clinical importance, assessment and management of patient functioning in schizophrenia in Europe, the Middle East and Africa. Ann Gen Psychiatry. 2013;12(8):1–8. doi:10.1186/1744-859X-12-8
  • Valencia M, Fresán A, Barak Y, et al. Predicting functional remission in patients with Schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome. Neuropsychiatr Dis Treat. 2015;11:2339–2348. doi:10.2147/NDT.S87335
  • Penn DL, Mueser KT. Research update on the psychosocial treatment of schizophrenia. Am J Psychiatry. 1996;153:607–617.
  • Marder SR, Integrating pharmacological and psychosocial treatments for schizophrenia. Acta Psychiatr Scand. 2000;Suppl 407:87–90. doi:10.1034/j.1600-0447.2000.00017.x
  • Kopelowicz A, Liberman RP. Integrating treatment with rehabilitation for persons with major mental illnesses. Psychiatr Serv. 2003;54(11):1491–1498. doi:10.1176/appi.ps.54.11.1491
  • Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30(2):193–217. doi:10.1093/oxfordjournals.schbul.a007071
  • Pfammatter M, Junghan UM, Brenner HD. Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophr Bull. 2006;32(Suppl1):S64–S80. doi:10.1093/schbul/sbl030
  • Liberman RP. Recovery from Disability. Manual of Psychiatric Rehabilitation. American Psychiatric Publishing, Inc; 2008.
  • Dixon LB, Dickerson F, Bellack AS, et al.; Schizophrenia Patient Outcomes Research Team (PORT). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull. 2010;36(1):48–70. doi:10.1093/schbul/sbp115
  • Valencia M, Rascón ML, Juárez F, et al. Application in Mexico of psychosocial rehabilitation with schizophrenia patients. Psychiatry. 2010;73(3):248–326. doi:10.1521/psyc.2010.73.3.248
  • Valencia M, Diaz A, Juarez F. Integration of pharmacological and psychosocial treatment in Mexico: the case of a developing country proposal. Pharmacotherapy. 2012;3:41–68.
  • Valencia M, Fresan A, Juárez F, et al. The beneficial effects of combining pharmacological and psychosocial treatment on remission and functional outcome in outpatients with schizophrenia. J Psychiatr Res. 2013;47:1886–1892. doi:10.1016/j.jpsychires.2013.09.006
  • Valencia M, Moriana JA, Kopelowicz A, et al. Social skills training for Spanish-speaking persons with schizophrenia: experiences from Latin America, Spain and the USA. Am J Psychiatr Rehabil. 2015;18(3):209–246. doi:10.1080/15487768.2014.954161
  • Valencia M, Fresán A, Kopelowicz A, et al. Symptomatic remission and functional recovery in outpatients with schizophrenia. Adv Schizophr Res. 2018;47:1–20.
  • Lin A, Wood SJ, Yung AR. Measuring psychosocial outcome is good. Curr Opin Psychiatry. 2013;26:0951–7367. doi:10.1097/YCO.0b013e32835d82aa
  • Andreasen NC, Carpenter WT, Kane J, et al. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 2005;162(3):441–449. doi:10.1176/appi.ajp.162.3.441
  • Leucht S, Lasser R. The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry. 2006;39(5):161–170. doi:10.1055/s-2006-949513
  • Burns T, Patrick D. Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatr Scand. 2007;116(6):403–418. doi:10.1111/j.1600-0447.2007.01108.x
  • Birchwood M, Smith J, Cochrane R, et al. The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br J Psychiatry. 1990;157:853–859. doi:10.1192/bjp.157.6.853
  • Peuskens J, Gorwood P. How are we assessing functioning in schizophrenia ? A need for a consensus approach. Eur Psychiatry. 2012;27:391–395. doi:10.1016/j.eurpsy.2011.02.013
  • Morosini P, Magliano L, Brambilla LO, et al. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101:323–329. doi:10.1111/j.1600-0447.2000.tb10933.x
  • Saraswat N, Rao K, Subbakrishna DK, et al. The Social Occupational Functioning Scale (SOFS): a brief measure of functional status in persons with schizophrenia. Schizophr Res. 2006;81:301–309.
  • Whitehorn D, Brown J, Richard J, et al. Multiple dimensions of recovery in early psychosis. Int Rev Psychiatry. 2002;14:273–283. doi:10.1080/0954026021000016914
  • Harding CM, Brooks GW, Ashicaga T, et al. The Vermont longitudinal study of persons with severe mental illness: II. Long term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. Am J Psychiatry. 1987;144:727–735.
  • Goldman HH, Skodol AE. Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry. 1992;149:9. doi:10.1176/ajp.149.1.9
  • Menezes NM, Arenovich T, Zipursky RB. A systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med. 2006;36(10):1349–1362. doi:10.1017/S0033291706007951
  • Torgalsbøen AK, Rishov Rund B. Maintenance of recovery from schizophrenia at 20-year follow-up: what happened? Psychiatry. 2010;73(1):70. doi:10.1521/psyc.2010.73.1.70
  • Lambert M, De Marinis T, Pfeil J, et al. Establishing remission and Good clinical functioning in schizophrenia: predictors of best outcome with long-term risperidone long-acting injectable treatment. Eur Psychiatry. 2010;25:220–229. doi:10.1016/j.eurpsy.2009.09.001
  • Henry LP, Amminger GP, Harris M, et al. The EPPIC follow-up study of first-episode psychosis:longer-term clinical and functional outcome 7 years after index admissions. J Clin Psychiatry. 2010;71(6):716–728. doi:10.4088/JCP.08m04846yel
  • Hopper K, Harrison G, Wanderling JA. An overview of course and outcome in ISoS. In Recovery from schizophrenia. An international perspective. A report from the WHO collaborative project. In: Hopper K, Harrison G, Janca A, Sartorios N, editors. The International Study of Schizophrenia. Oxford University Press; 2007:23–38.
  • Bobes J, Ciudad A, Alvarez E, et al. Recovery from schizophrenia: results from a 1-year follow-up observational study of patients in symptomatic remission. Schizophr Res. 2009;115(1):58–66. doi:10.1016/j.schres.2009.07.003
  • San L, Ciudad A, Alvarez E, et al. Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: prevalence and associations in a cross-sectional study. Eur Psychiatry. 2007;22(8):490–498. doi:10.1016/j.eurpsy.2007.06.005
  • Doornbos MM. Predicting family health in families of young adults with severe mental Illness. J Fam Nurs. 2002;8(3):241–263. doi:10.1177/107484070200800306
  • Magliano L, Fiorillo A, De Rosa C, et al. National mental health project working group. Family burden in long-term diseases: a comparative study in schizophrenia vs. physical disorders. Soc Sci Med. 2005;61(2):313–322. doi:10.1016/j.socscimed.2004.11.064
  • Falloon RH, Boyd J, McGill CW. Family Care of Schizophrenia: A Problem Solving Approach to the Treatment of Mental Illness. The Guildford Press; 1984.
  • Valencia M, Rascón ML, Quiroga H. Aportaciones de la investigación respecto al tratamiento psicosocial y familiar de pacientes con esquizofrenia. Salud Ment. 2003;26(5):1–18.
  • Goffman E. Essays on the Social Situation of Mental Patients and Other Inmates. Anchor Books Edit; 1961.
  • Kane JM. Review of treatments that can ameliorate adherence in patients with schizophrenia. J ClinPsychiatry. 2006;67(Suppl 5):9–14.
  • Gilbert PL, Harris J, McAdams LA, et al. Neuroleptic withdrawal in schizophrenia patients: a review of the literature. Arch Gen Psychiatry. 1995;52:173–188. doi:10.1001/archpsyc.1995.03950150005001
  • Xiao J, Mi W, L. L, et al. High relapse rate and poor medication adherence in the Chinese population with schizophrenia: results from an observational survey in the People’s Republic of China. Neuropsychiatr Dis Treat. 2015;11:1161–1167. doi:10.2147/NDT.S72367
  • Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Eng J Med. 2005;353:1209–1223.
  • Perkins DO. Predictors of nonadherence in patients with schizophrenia. J Clin Psychiatry. 2002;63:12–16. doi:10.4088/JCP.v63n1206
  • American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia, Second Edition. Am J Psychiatry. 2004;161(2):1–56.
  • National Institute for Clinical Excellence. Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. London: NICE; 2002.
  • Castle D, Copolov DL, Wykes T, et al. Pharmacological and Psychosocial Treatments in Schizophrenia. Informa Health Care; 2008.
  • Verduzco W. Guía basada en la evidencia de la Asociación Psiquiátrica de América Latina y de la Asociación Psiquiátrica Mexicana para el tratamiento del paciente con esquizofrenia. [Evidence-based guideline of the Latin American Psychiatric Association and the Mexican Psychiatric Association for the treatment of patients with schizophrenia]. Salud Ment. 2014;37:S1–S118. Spanish.
  • Dixon L, Stewart B, Burland J, et al. Pilot study of the effectiveness of the family-to-family education program. Psychiatric Servi. 2001;52(7):965–967. doi:10.1176/appi.ps.52.7.965
  • Brown GW. The mental hospital as an institution. BrJ Psychiatry. 1977;130:1–18. doi:10.1192/bjp.130.1.1
  • Leff J, Vaughn C. Expressed Emotion in Families. New York: Guildford Press; 1985.
  • Kuipers E, Leff J, Lam DE. Guía práctica de trabajo con las familias. [Esquizofrenia/ Family Work for Schizophrenia]. In: Published by Arrangements with the Royal College of Psychiatrists. London: Ediciones Paidos Iberica; 2004. Spanish.
  • Birchwood M, Spencer E. Schizophrenia: early warning signs. Adv Psychiatr Treat. 2000;6:93–101. doi:10.1192/apt.6.2.93
  • Mari J, Streiner D. Family intervention for those with schizophrenia. In: Cochrane Library. London: BMJ Publications; 1996.
  • Kreyenbuhl J, Buchanan RW, Dickerson FB, et al. The schizophrenia patient outcomes research team (PORT): updated treatment recommendations 2009. Schizophr Bull. 2010;36(1):94–103. doi:10.1093/schbul/sbp130
  • Prince M, Patel V, Saxena. S. No health without mental health. Lancet. 2007;370:859–877. doi:10.1016/S0140-6736(07)61238-0
  • Tandon R, Keshavan MS, Nasrallah HA, Schizophrenia A. “just the facts”: what we know in 2008 part 1: overview. Schizophr Res. 2008;100:4–19. doi:10.1016/j.schres.2008.01.022
  • Murray CJL, Lopez AD. Global Health Statistics; a Compendium of Incidence, Prevalence and Mortality Estimates for Over 200 Conditions. Cambridge: Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1996.
  • Ustun B, Kennedy C. What is “functionally impairment”? Disentangling disability from clinical significance. World Psychiatry. 2009;8:82–85. doi:10.1002/j.2051-5545.2009.tb00219.x
  • MacDonald A, Schultz C. What we know: finds that every theory of schizophrenia should explain. Schizophr Bull. 2009;35(3):493–508. doi:10.1093/schbul/sbp017
  • Barbato A. Schizophrenia and public health/Angelo Barbato. In: WHO Nations for Mental Health Initiative & World Health Organization. Division of Mental Health and Prevention of Substance Abuse‎. World Health Organization; 1997.
  • Fresán A, Robles-García R, Cota M, et al. Actitudes de mujeres estudiantes de psicología hacia las personas con trastornos mentales graves: relación con la percepción de agresividad y peligrosidad. Salud Ment. 2012;35:215–223.
  • Mohamed S, Rosenheck R, Swartz M, et al. Relationship of cognition and psychopathology to functional impairment in schizophrenia. AmJ Psychiatry. 2008;165(8):978–987. doi:10.1176/appi.ajp.2008.07111713
  • Bowie CR, Best MW, Depp C, et al. Cognitive and functional deficits in bipolar disorder and schizophrenia as a function of the presence and history of psychosis. Bipolar Disord. 2018;20(7):604–613. doi:10.1111/bdi.12654
  • Dixon L. Educating and Empowering Families. Harvard Mental Health Letter; 2011.
  • World Health Ornization. Informe sobre la salud en el mundo 2001. Salud mental: Nuevos conocimientos, nuevas esperanzas. [The World health report: 2001: Mental health: new understanding, new hope]. Ginebra, Suiza: World Health Organization; 2001. Spanish.
  • Murray CJL, Lopez AD. Global mortality, disability, and the contributions of risk factors: global burden of disease study. Lancet. 1979;349:1436–1442. doi:10.1016/S0140-6736(96)07495-8
  • Jobe TH, Harrow M. Long-term outcome of patients with schizophrenia: a review. Can J Psychiatry. 2005;50:892–900. doi:10.1177/070674370505001403
  • Oldridge ML, Hugues ICT. Psychological well-being in families with a member with a member suffering from schizophrenia: an investigation into long-standing problems. Br J Psychiatry. 1992;161:249–251. doi:10.1192/bjp.161.2.249
  • Shrivastava AK, Stitt L, Thakar M, et al. The abilities of improved schizophrenia patients to work and live independently in the community: a 10-year Long-term Outcome Study from Mumbai, India. Ann Gen Psychiatry. 2009;8:24. doi:10.1186/1744-859X-8-2
  • Valencia M, Caraveo J, Colin R, Verduzco W, Corona F. Remisión sintomática y recuperación funcional en pacientes que padecen esquizofrenia. Salud Ment. 2014;31(1):59–74. doi:10.17711/SM.0185-3325.2014.008
  • Emsley R, Chiliza B, Asmal L, et al. The concepts of remission and recovery in schizophrenia. Curr Opin Psychiatry. 2011;24(2):114–121. doi:10.1097/YCO.0b013e3283436ea3
  • AlAqueel B, Margolese HC. Remission in schizophrenia: critical and systematical review. Harv Rev Psychiatry. 2012;20:281–297. doi:10.3109/10673229.2012.747804
  • Schennach-Wolff R, Jäger M, Seemüller F, et al. Defining and predicting functional outcome in schizophrenia and schizophrenia spectrum disorders. Schizophr Res. 2009;113(2–3):216–217. doi:10.1016/j.schres.2009.05.032
  • Falloon IRH, Montero I, Zihni Sungur M, et al. Implementation of evidence-based treatment for schizophrenic disorders: two-year outcome of an international field trial of optimal treatment. World Psychiatry. 2014;3(2):104–109.
  • Fervaha G, Agid O, Takeuchi H. Life satisfaction among individuals with schizophrenia in the clinical antipsychotic trial of Intervention effectiveness (CATIE) study. Am J Psychiatry. 2013;170:1061–1062. doi:10.1176/appi.ajp.2013.13010060
  • Harvey PD. Disability in schizophrenia: contributing factors and validated assessments. J Clin Psychiatry. 2014;75(Suppl 1):15–20. doi:10.4088/JCP.13049su1c.03
  • Robinson DG, Woerner MG, McMeniman M, et al. Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. Am J Psych. 2004;161(3):473–479. doi:10.1176/appi.ajp.161.3.473
  • Iasevoli F, Giordano S, Balletta R, et al. Treatment resistant schizophrenia is associated with the worst community functioning among severely-ill high-disabling psychiatric conditions and its most relevant predictor of poorer achievements in functional milestones. Prog Neuropsychopharmacol Biol Psychiatry. 2016;65:34–48. doi:10.1016/j.pnpbp.2015.08.010
  • Mojtabai R, Fochtmann L, Chang SW, et al. Unmet need for mental health care in schizophrenia: an overview of literature and new data from a first-admission study. Schizophr Bull. 2009;53(4):679–695. doi:10.1093/schbul/sbp045
  • Drake RE, Essock SM. The science-to-service gap in real-world schizophrenia treatment: the 95% problem. Schizophr Bull. 2009;35(4):677–678.