بهزیستی ذهنی، اما نه عملکرد ذهنی نشان دهنده ارتباط مثبت با عملکرد عصبی در اختلالات طیف اسکیزوفرنی

Abstract Objective To assess the association of subjective quality of life as measured by the Subjective Well-being under Neuroleptic Treatment questionnaire (SWN-K) with neuropsychological functioning; to address interactions with the SWN-K domain mental functioning as a measure of subjective cognitive dysfunction; and to examine the interaction of subjective well-being and psychopathology ratings. Methods Forty-five patients diagnosed with schizophrenia spectrum disorder (SSD) were assessed regarding subjective well-being (SWN-K), neuropsychological impairment, and psychopathology (Brief Psychiatric Rating Scale; BPRS). Results After controlling for multiple comparisons, SWN-K total score showed significant positive correlations with concentration/attention (r = .498), working memory (r = .537), verbal memory (r = .522), and global cognition (r = .459). No correlations of SWN mental functioning and neuropsychological impairment remained significant after Bonferroni correction. Correlations between SWN-K subscales and neuropsychological functioning were generally positive, indicating higher subjective well-being in patients with better neurocognition. In multivariate analyses, global cognition was a significant predictor (p = .011), accounting for 19.7% of SWN total score variance. Adding BPRS total score as predictor (p = .054) explained an additional 6.9% of SWN-K variance. Linear regression analyses with SWN-K mental functioning as dependent variable did not yield statistically significant models. Conclusion Subjective well-being and objective neuropsychological functioning show only moderate associations and can be seen as largely independent parameters. In particular, subjective mental functioning cannot serve as a proxy for objective neuropsychological testing.

Introduction Quality of life (QoL) and neuropsychological dysfunction have been found to influence course and outcome in schizophrenia [1]. The Subjective Well-being under Neuroleptic Treatment scale (SWN) developed by one of the authors [2] and [3] and its short form (SWN-K) are the most widely used self-rating scales in recent research of subjective well-being in schizophrenia. The SWN has been shown to be a valuable outcome measure in clinical studies [4]. Subjective well-being has strong influence on compliance with antipsychotic medication [5] and impact on symptomatic outcome [6]. Amelioration of subjective well-being predicts severity of illness, negative syndrome, and social and occupational functioning [7]. Regarding psychopathology, there is broad evidence that depressive, but not positive or negative symptoms as measured with the Positive and Negative Symptom Scale (PANSS) are significantly associated with poorer subjective quality of life [8], [9], [10] and [11]. Regarding the SWN-K, associations of low to medium effect size with PANSS subscales have been reported [2], [3] and [12]. In particular, depressive symptoms had a negative impact on subjective well-being [13] and [14]. As quality of life and neuropsychological functioning predict outcome and recovery, there is growing interest in the interactions between these domains. In a recent meta-analysis, Tolman & Kurtz [15] reported that, while some studies found no significant associations, others found significant negative associations between subjective QoL and neurocognitive performance, and that accordance was better for objective QoL. While insight is discussed as a moderating factor leading to the inverse relation between subjective QoL and neurocognition, this could not be shown in a recent study [11]. Up to now, the association between neuropsychological functioning and subjective well-being as rated with the SWN-K has not yet been examined in scientific literature. Furthermore, the connection of neuropsychological dysfunction and SWN-K mental functioning as a subjective measure of cognition is unclear. 1.1. Aims of study The current study was conducted to assess the association of subjective QoL as measured by the SWN-K with neuropsychological functioning and psychopathology; and to explore the relationship of these domains with the SWN-K subscale “mental functioning” as a measure of subjective cognitive dysfunction.

. Conclusion Subjective well-being and objective neuropsychological functioning show only moderate associations and can be seen as largely independent parameters. In particular, subjective mental functioning cannot serve as a proxy for objective neuropsychological testing, and both measures have to be integrated in clinical studies. The patients’ perception may differ considerably from objectively identified neuropsychological dysfunction. However, the lack of associations between subjective and test based assessments could also be due to a disparity of concepts regarding neuropsychological functioning. It is, therefore, recommended that therapists ask patients for their perspective to gain a more complete view than neuropsychological testing alone can provide. Incorrect estimation of neuropsychological impairments may lead to further problems for the patients, for example to depressed mood or an increased subjective handicap in getting employed due to underestimation by the patient or his therapist, or to taking on inadequate challenges due to overestimation and subsequent frustration. Clearly, more research is warranted in the area of subjective cognitive impairments.