Negative symptoms and functioning in institutionalized versus outpatient schizophrenic patients

Abstract

Background Schizophrenia is among the top 10 disabling conditions worldwide among young adults. Negative symptoms contribute more toward poor functional outcome and quality of life for individuals with schizophrenia than positive symptoms. Many studies have suggested that institutionalization affects social functioning and quality of life significantly; yet, there is still ongoing debate on the optimal duration of hospital stay as a rapid and early discharge can lead to higher rates of relapse and rehospitalization. Objectives This study aimed to examine the phenomenology of institutionalized schizophrenic patients and assess the impact of institutionalization on negative symptoms and overall functioning. Patients and methods Two groups of schizophrenic patients between 30 and 60 years of age and who had schizophrenia for at least 2 years were studied. Group I included 20 institutionalized schizophrenic patients in Al Abbassia Mental Hospital and group II included 20 outpatient schizophrenic patients. The diagnosis was confirmed by ICD10 in all patients, followed by assessment with a positive and negative symptom scale, the global assessment of functioning (GAF) scale, and the Wechsler adult intelligence scale. Results Positive and negative symptoms scale showed a statistically significant difference in delusions and hallucinatory behavior (P= 0.05), passive social withdrawal, and total negative symptoms score (P= 0.05) in institutionalized patients, and also in disorientation and lack of judgment and insight (P =0.05); on GAF, in group II, the scores were statistically significantly worse (P = 0.00). Conclusion Negative symptoms on positive and negative symptoms scale are worse in outpatients and GAF is better in outpatient schizophrenics, confirming that institutionalization can have a negative impact on schizophrenic patients and their ability to return to community life.