Attitudinal beliefs feed negative schizophrenia symptoms

Dysfunctional attitudes and low self-efficacy are associated with poorer functioning in patients with early schizophrenia, and this relationship is partly mediated by negative symptoms, shows research.

The findings support a model in which dysfunctional attitudinal beliefs contribute to negative symptoms, which in turn impact on daily functioning, say lead study author Joseph Ventura (University of California, Los Angeles, USA) and colleagues.

“Another interpretation is that the lower levels of dysfunctional attitudes contribute to absence of negative symptoms, which in turn leads to better functioning,” they write in Schizophrenia Bulletin.

The team identified these associations in patients with early schizophrenia; psychotic symptoms in the 71 study participants had started 5.9 months previously, on average.

This suggests that dysfunctional attitudes and low self-efficacy are “enduring, core features of schizophrenia”, and could influence illness course, say the researchers.

The patients had significantly lower self-efficacy than 20 age-matched mentally healthy controls, as assessed with the Self-Efficacy Scale. In particular, patients felt poorly equipped to invite someone on a date.

Patients also had lower scores than controls on the Dysfunctional Attitudes Scale, especially for the Defeatist Performance Attitudes subscale. No single item stood out, says the team, with patients scoring uniformly low on all items.

Both self-efficacy and dysfunctional attitudes were associated with patients’ global scores on the Role Functioning Index, and with several individual domains, as were premorbid functioning, neurocognition and negative symptoms. Self-efficacy and dysfunctional attitudes, particularly defeatism, were also related to negative symptoms.

In mediation models, dysfunctional attitudes and self-efficacy had partial influences on negative symptoms, and negative symptoms had a significant impact on functioning. Self-efficacy also had an impact on neurocognition, which in turn affected functioning.

“These findings have potential implications for implementing effective interventions that aim to improve daily functioning in early course schizophrenia patients,” say Ventura et al.

They say that no intervention has thus far had more than a limited effect on negative symptoms or cognition, but dysfunctional attitudes and low self-efficacy “may be additional, but less proximal targets” for cognitive therapy, providing “an indirect way to improve functioning by reducing negative symptoms.”

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