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Factors of ADL/IADL associated with negative symptoms in long-term inpatients with schizophrenia

Ebisu, Tomoe Hashimoto, Takeshi Sakurai, Tomomi Sawada, Tomonori Kawashima, Yoshiki Yotsumoto, Kayano 神戸大学

2023

概要

Despite Japan’s extensive efforts over the last half-century to move individuals with mental illness
from hospitals to community living, the challenge of long-term hospitalization persists. This is especially
true for those with schizophrenia, who have been hospitalized for over a year, known as long-term
hospitalization1). The “Reform Vision for Health, Medical Care, and Mental Health Welfare” initiative was
launched from 2004 to 2013 to promote the discharge of long-term inpatients, but the goal of reducing their
numbers was not achieved. As of 2022, there were still approximately 100,000 long-term inpatients with
schizophrenia, making up around 60% of all long-term psychiatric care beds2). This highlights the ongoing
inadequacy of the transition to community-based care. Therefore, there is a need to establish effective
interventions to facilitate their discharge, which requires a comprehensive investigation of inpatient
characteristics.
Estimates suggest that a proportion, ranging approximately between 19% and 51%, of long-term
inpatients with schizophrenia in Japan expressed a lack of interest in being discharged 3-7). Regrettably,
since the conclusion of the aforementioned national initiative in 2013, there has been a stagnation in this
trend, with the percentage persisting at approximately 21% to 40%8,9). Notably, among the various
hindering factors of discharge, negative symptoms associated with schizophrenia emerge as contributing
factors10).
These symptoms have a direct impact on their daily living activities11-13), and while pharmacotherapy
can have limited effectiveness, psychosocial therapy has been recommended in combination with
medication14). There is moderate evidence that psychosocial therapy improves negative symptoms15).
However, it remains unclear which specific activities of daily living (ADL)/instrumental activities of daily
living (IADL) should be targeted to address negative symptoms through psychosocial therapy. Additionally,
various sociodemographic factors have been associated with negative symptoms9,16-18).
This study aimed to explore factors related to negative symptoms in long-term inpatients with
schizophrenia, with a focus on assessing ADL/IADL performance and sociodemographic variables. By
identifying these factors, the study can help inform the development of interventions that combine
psychosocial therapy and pharmacotherapy to address negative symptoms better, ultimately promoting
successful transitions to community living. ...

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