Schizophrenia, instrumental activities of daily living and executive functions: a qualitative multidimensional approach

Macedo, Mônica; Marques, António; Queirós, Cristina; Mariotti, Milton Carlos

doi:10.4322/2526-8910.ctoAO1153

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Original Article • Cad. Bras. Ter. Ocup. 26 (02) • Apr 2018 • https://doi.org/10.4322/2526-8910.ctoAO1153 copy

Schizophrenia, instrumental activities of daily living and executive functions: a qualitative multidimensional approach¹ 1 Study approved by the opinion nº 673/2014 of the Ethics Committee of the Higher School of Health Technology of Porto and by the opinion nº 638.793 of the Ethics Committee of the Health Sector of the Federal University of Paraná. Work linked to the Ph.D. research project: “Rehabilitation of the executive functions of people with schizophrenia: proposal of a serious game contextualized in the instrumental activities of daily life” (FPCE -UP).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

People with schizophrenia often present difficulties in social and occupational reintegration that may be associated with problems in performing daily activities. Executive dysfunction is one of the factors associated to these difficulties.

Objective:

In this study we sought to know and analyze the potentialities and difficulties of people with schizophrenia regarding the Instrumental Activities of Daily Living, specifically the components related to executive dysfunction through the perception of people with schizophrenia, family members and professionals who participate in support associations in Brazil and In Portugal. Method: Data was obtained through 2 focus groups for each representation (users, family and professionals), with a mean of 6.7 participants per group (N=40). Data were analyzed through Interpretive Phenomenological Analysis.

Results:

We identified three main themes and their respective subtopics: The to (not) do in its essence - lack of meaning, dissatisfaction and lack of autonomy; Impediments - decreased volition, inflexibility and action and difficulty in planning routines and tasks; Environmental factors - family, association and professionals.

Conclusion:

We conclude that the insufficiency in the occupational performance of people with schizophrenia in relation to IADL, directly related to executive dysfunction, reveals the importance of specific rehabilitation programs for this population, aiming at cognitive and occupational improvements.

Keywords:
Schizophrenia; Executive Function; Daily Activities

	Portugal (n=6)	Brazil (n=6)
Profession
Occupational Therapist	3	2
Psychologist	3	2
Social worker	0	2
Age [M (SD)]	31.5 (3.9)	52 (13.3)
Academic Degree
Doctorate degree	2	1
Master	2	2
University graduate	2	3
Years of experience [M(SD)]	7.6 (4.4)	17 (9.2)

	Portugal (n=9)	Brazil (n=7)
Gender
Male	7	4
Female	2	3
Age (years old) [M (SD)]	40.33 (6.0)	44.8 (12.6)
Educational level (years) [M (SD)]	12.3 (3.2)	11.5 (2.8)
Marital status
Single	9	5
Married	0	1
Divorced	0	1
Widow	0	0
Time of the disease (years) [M (SD)]	13.11 (9.4)	20.4 (8.9)
Live with
Family	5	6
Alone	3	1
Institution	1	0

	Portugal (n=6)	Brasil (n=6)
Gender
Male	3	3
Female	3	3
Age (years old) [M (SD)]	59.6 (11.9)	55.3 (19.2)
Educational level (years) [M (SD)]	11.8 (1.8)	12.1 (1.6)
Marital status
Single	0	1
Married	4	5
Widow	2	0

Main Themes	Sub-themes	Excerpts from the stories	Related Executive Function (LEZAK et al., 2004LEZAK, M. D. et al. Neuropsychological assessment. New York: Oxford University Press Norris, 2004.)
The doing (or not) in its essence	Lack of meaning	[...] there is always that impression that you should not and do not have to do things by yourself... you have to be doing things for others (UB3). [...] it does not care if the house is turned over (FB4). [...] but if you do not say these things (the need to organize the kitchen and the bedroom) you do not have great care... They seem lazy, but they are not, they can not even do things (FP3).	Volition
	Dissatisfaction	[...]. My mother helps me in housekeeping... I do not have big aspirations to have a model home, but it’s just as organized as I need (UP7). [...]. There is a great distance between what is right for them and what the family requires minimally, so they (family members) prefer that they do not even do it... (PP3).” [...] in her head she has no difficulty doing anything in the house, but she does everything very weak... (FB1).	Effective Performance
	Lack of autonomy	[...] yes, he does all this, any of these activities, but he has to order... (FB2). [...] you have to always be giving this space, this opportunity for my relatives to tell me what I have to do, how to do it as if I were a puppet, we get a little annoyed at it (UB3). [...] They have to say what you have to do. (FP3).	Intentional action
Limitations	Decrease in volition	[...] I live alone... there are times when there is no will to take care of me... for example going shopping (UP2). [...] I know how to go, which bus to take, but if I did not plan it the day before, I did not think about everything in advance, I do not have the mood, I will not go (UB2).	Volition
Limitations	Inflexibility of thought and action	[...] The impression I have is that the problem is rigor, lack of flexibility and adaptability. (FB2). [...]. It’s like that little doll that you wind up, he walks straight, hit an obstacle he gets there trying infinitely (FB1). [...] I said so many times, I have already shown that it is wrong, and continues to err, to err, I have already seen that it is not purposeful... (FP3).	Intentional action
	Difficulty in planning and organizing routines and tasks	[...] that is a complete disorganization, but she knows where things are, she lives in that mess... the biggest problem is the disorganization, it’s all disorganized at home. (FP4). [...] a great difficulty to deal with them is the planning, they can not organize an activity (PP1). [...] I feel guilty... I do not take good care of the house, I take care, but not as I wanted, well organized (UB1).	Effective Performance
Environmental factors (facilitators and barriers)	Family	[...] my parents have to keep telling me to do it, otherwise, I’m delay it (UB3). [...] I know how to do some things, but my mother prefers to do it (UP8). [...] many of them have their skills worked on, but families do not allow them to do their homework (PP3).
	Forums and Associations	[...] the association was light at the end of the tunnel (UP3). [...] I need to be encouraged, or else I do not, here (Association) I at least feel less different (UB4). [...] she improved a lot after she came here (FP1). [...] one thing he’s excited about is coming in the association (FB3).
	Health and Social Care Professionals	[...] And so the area of functionality of the IADL makes a lot of sense because they have so many deficits, they are much more complex tasks, which I think it requires more differentiated training and that many times we do not get them to have the result required. (PP4.) [...] there are programs that are more laboratory, and then do not pass into real life... we have a training of purchases in the computer... We did a preliminary study and we did not find results with very significant differences between the final and initial evaluation. (PP1). [...] Persistence and getting too close... A few years ago, I started working with cognitive therapy, and that’s what works with them. Working every situation... (PB1) [...]. But it takes a long time... in some cases we can not change certain behaviors, but they have learned to make coffee, it was valued... (PB2)

Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[1] Corresponding author:
Mônica Macedo, Universidade Federal do Paraná, Rua Desembargador Motta, 345/02, CEP 80430-200, Curitiba, PR, Brasil, e-mail: terapeutamonica@hotmail.com