مدولاسیون حسی و مشارکت روزانه زندگی در افراد مبتلا به اسکیزوفرنی

Schizophrenia is considered to be an extreme mental health disturbance that affects a person's well-being and participation in everyday activities. Participation in meaningful everyday occupations is an important component of recovery from mental illness, the ultimate goal of mental health services. The participation restrictions of people with schizophrenia have been widely investigated through different factors, such as illness symptoms and course, cognition, and demographic data; however, the resulting explanations were incomplete. The purpose of the study was to explore the contribution of sensory modulation (SM), in addition to cognition and schizophrenia symptoms, to participation in daily life activities of people with schizophrenia. Forty nine in-patients with schizophrenia (study group) and 32 adults without mental illness (control group) comprised the study. They were assessed for their participation patterns, sensory modulation processes, cognitive functioning and symptoms severity. Results indicate significant differences between the study groups in most measurements addressed: participation (diversity and satisfaction), sensory modulation scores (intensity of the response and frequency of response), and cognitive measurements. The most contributive parameters for the prediction of participation dimensions among people with schizophrenia were negative symptoms severity and general cognitive status. In conclusion, people with schizophrenia experience SM disorder with an under responsive tendency. However the complex condition of schizophrenia dominates its influence on participation dimensions.

Schizophrenia is considered to be an extremely debilitating mental health condition that affects 1% of the world's population [1]. The treatment for schizophrenia is challenging both with respect to its therapeutic and its economic aspects. It is a persistent condition that has long-lasting effects on the health, well-being and participation in everyday activities of individuals with schizophrenia and entails high levels of health care expenditures, social payments and family involvement [1] and [2]. Today, primary goal of mental health services for individuals with mental illness is recovery [3]. Although a variety of definitions for recovery of mental illness are found in the literature, most highlight participation in meaningful everyday occupations as its significant component [3] and [4]. Participation is particularly relevant in schizophrenia, since this illness has been found to impede function and participation in many areas of life such as self-care, care of others, home maintenance, employment and personal communication [1], [5], [6] and [7]. People with schizophrenia tend to participate in fewer activities of daily life and their participation is less frequent [5], [6] and [7]. In recent decades, the participation restrictions of people with schizophrenia have been extensively investigated. Research has indicated that these restrictions are related to a variety of factors, such as its symptoms, cognition [8], [9], [10], [11] and [12], the course of the illness and various demographics factors [13] and [14]. Although these factors have been shown to correlate highly with participation in everyday activities among individuals with schizophrenia, they do not completely explain the variance found in their functional profiles [8], [9] and [13]. Currently, much attention has been focused on the impact of sensory modulation (SM) dysfunction on everyday participation [15] and [16]. SM is defined as the central nervous system's capacity to regulate and organize the degree, intensity and nature of one's responses to sensory input in a graded and adaptive manner. Thus, SM enables one to achieve and maintain efficient behavioral responses, which in turn facilitate effective daily adaptation [16]. Sensory modulation disorder (SMD) interferes with modulation across one or multiple sensory systems [17], [18] and [19], and is manifested in reduced participation in daily life occupations [15] and [20]. Subtypes of SMD include sensory over-responsivity (SOR), in which non-painful sensations are perceived as abnormally aversive, irritating [16], [17] and [18] or painful [21] and [22]; and sensory under-responsivity (SUR), which manifests as decreased and/or delayed responses to stimuli [16], [17] and [18]. Most of the knowledge is based on studies focusing on pediatric population [15], [16], [17], [18], [19], [20], [21], [22], [23], [24] and [25], however SMD has also been documented in adulthood [26] and [27], although prevalence among adults has not yet been reported. Studies examining aspects of mental health among adults with SMD found a positive relationship between anxiety and sensitivity to environmental stimuli, as well as correlations between affect and sensory patterns [28] and [29]. Moreover, in comparison to controls, adults with over-responsivity demonstrate depression, anxiety and maladjustment, as well as lower scores in the physical and mental dimensions of health related quality of life assessments [30]. Only a few studies have examined the occurrence of SMD in schizophrenia, but their findings have reported that people with schizophrenia experience a high rate of neurodevelopmental sensory modulation deficits (e.g. [26], [31], [32] and [33]). These deficits have been identified at very early stages of cortical and subcortical visual, auditory and somato-sensory processing [32] and [34]. Moreover, it has been suggested that a person may manifest abnormal patterns of sensory processing prior to the onset of schizophrenia and that these abnormal patterns may even factor in the emergence of the condition [32], [33], [34] and [35]. All sensory modalities were found to be affected in schizophrenia; however the most significant impairments were found in the visual and auditory systems [34] and [36]. Within the population of individuals with mental illness, people with schizophrenia tend to avoid sensory stimuli more so than individuals with bipolar disorder [26] and [37]. Sensory modulation serves as a foundation for basic information processing. Thus, SMD may interrupt normal cognitive and emotional processing [38]. For example, impairments in SM lead to ‘perceptual incoherence’ and abnormal self-experience, which may in turn cause alterations of complex psychological functions (e.g. depersonalization, ambivalence, diminished sense of agency) and disturbances of various social behaviors and outcomes (e.g., difficulty interpreting social situations and categorizing emotional responses and facial expressions) [36], [39] and [40]. However, little is known about the influence of SMD on participation in everyday life activities among people with schizophrenia. The purpose of the study was to explore the contributions of sensory modulation, cognition and schizophrenia symptoms to the participation of people with schizophrenia.