Dimensione disorganizzazione in corso di schizofrenia e funzionamento sociale

Objectives: "Disorganization syndrome" was first described by Eugen Bleuler, who gave the term "dissociation" a core function in schizophrenia. "Disorganization" is characterized by the presence of three basic elements: a) disintegration of fundamental characteristics of communication with related impossibility to decode the message; b) loss of logical connecting associations between communication concepts; c) disconnection between verbal and non-verbal, emotionally hued communication. Over the last few years, factorial analyses conducted on psychopathological symptoms and signs in patients affected by Axis I mental disorders often yielded factors labelled as Disorganization, Disorganization Syndrome or Formal Thought Disorder which appear to show covariance of symptoms like Poor attention, Stereotyped thinking, Conceptual disorganization, Thought disorder, Disorientation, Difficulty in abstraction, Mannerism/posturing. The assessment of disorganization has a remarkable importance for many reasons in schizophrenia, where the level of thought disorganization widely influences both rehabilitation programmes and psychotherapeutic interventions. Furthermore, the disorganization dimension may represent a specific "target" for drug treatment, thus for the correct choice of a molecule or a drug combination according to their pharmacodynamic profiles. Finally, in the light of most recent evidence, thought disorganization represents an important construct for neurobiological studies. Analysing studies conducted on patients with schizophrenia, cognitive disorganization appears to correlate with impaired social and vocational functioning, and with more difficulty in acquiring psychosocial skills. Based on studies in the literature, disorganization appears to be the dimension that most predicts poor functioning. The main aim of this study is to assess disorganization and the possible correlation of this dimension with social functioning in patients with schizophrenia. The literature appears to support this working hypothesis although the lack of a disorganization-specific assessment scale might represent a bias in studies published to date. Methods: Sixty consecutive subjects with a DSM-IV-TR diagnosis of schizophrenia were recruited from three University clinical centers (Rome "La Sapienza -1 st Medical School", Rome "Tor Vergata", and L'Aquila). All subjects gave written consent to take part in the study. Baseline socio-demographic data (name, initials, age, sex, marital status) and disease-related data (diagnosis with DSM-IV-TR specifiers, duration of condition, past and current treatment, any note added) were collected for all subjects. To assess the dimension of disorganization, schizophrenic symptomatology and social functioning, the following assessment scales were used: Scale for the Measurement of Disorganization (SCADIS); 3-THREE, a brief scale for the assessment of psychosis: Positive And Negative Syndrome Scale (PANSS), and Global Assessment of Functioning scale (GAF). Results: The demographic and clinical characteristics of the sample are outlined in Table I. Total SCADIS scores highly correlated with the "thought disorder" subcluster (r: 0.076, p < 0,001), with the disorganization item of the PANSS (r: 0.088, p < 0.001) and with the cognitive disorganization item of the 3-THREE (r: 0.082, p < 0.001), confirming the sensitivity of the SCADIS in assessing the disorganization dimension. An inverse correlation between the severity of alteration of Social Functioning, on the one hand, and the severity of alteration of Communication Quality, of Symbolic Reference System, of Goal-setting and Abstraction Ability, on the other, emerged from the analysis of correlation between items of the SCADIS and those of the GAF, whereas no correlation could be found between the items exploring Reference Logic and Procedural Redundancy (Tab. III). The analysis of variance (ANOVA) of PANSS, Sca.Dis and 3-THREE scores, in our sample, subdivided into two groups with respect to social functioning (subjects with moderately and severely impaired social functioning and subjects with functioning inability in almost all areas) confirmed that subjects with the most severe functioning impairments score significantly higher on all assessment scales, except on the "activation" and "depression" PANSS clusters (Figs. 1-3). Conclusions: Results obtained showed total SCADIS scores to highly correlate both with the "disorganization" item of the PANSS and the "cognitive disorganization" 3-THREE item. Furthermore, they also correlated with the "thought disorder" PANSS subcluster. The results of this study appear to fully confirm the hypothesis of an inverse correlation between disorganization and social functioning. In fact, total SCADIS scores showed a significant inverse correlation with GAF scores. Data obtained showed that the highest scores on the three assessment scales (SCADIS, PANSS and 3-THREE) were found in the subgroup of patients with a greater reduction of social abilities. Hence, it is confirmed that a direct relationship exists between high level of psychopathology and marked reduction of social functioning. Our study appears to confirm data in the literature showing impaired social functioning to correlate closely to the severity of the psychopathological picture, in particular with disorganized thought.