Abstract
Disability is pervasive in schizophrenia and is refractory to current medication
treatments. Inability to function in everyday settings is responsible for
the huge indirect costs of schizophrenia, which may be as much as three times
larger than direct treatment costs for psychotic symptoms. Treatments for
disability are therefore urgently needed. In order to effectively treat disability,
its causes must be isolated and targeted; it seems likely that there are multiple
causes with modest overlap. In this paper, we review the evidence regarding
the prediction of everyday disability in schizophrenia. We suggest that cognition,
deficits in functional capacity, certain clinical symptoms, and various environmental
and societal factors are implicated. Further, we suggest that health status
variables, recently recognized as pervasive in severe mental illness, may
also contribute to disability in a manner independent from these other better-studied
causes. We suggest that health status be considered in the overall prediction
of real-world functioning and that interventions aimed at disability reduction
targeting health status may be needed, in addition to cognitive enhancement,
skills training, and public advocacy for better services.
