{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:49:58Z","timestamp":1760147398337,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The study aimed to assess the impact of clinical symptoms and cognitive impairment on disability in patients with paranoid schizophrenia (PS). Methods: 108 patients with schizophrenia were included (66 male and 42 female). Their average age was 38.86 \u00b1 10.02 years and the disease duration was 12.80 \u00b1 8.20 years, with mean disease onset of 24 years. Clinical symptoms were assessed with the PANSS, and cognitive performance was measured using a seven-item neurocognitive battery. The disability level of the subjects was assessed using the World Health Organization\u2014Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The relation between the variables studied was assessed using Spearman\u2019s rank correlation coefficient (rs) at a probability level of p &lt; 0.05. Results: An increase in symptom severity resulted in worsening of the \u201cparticipation in society\u201d (r = 0.56, p &lt; 0.01), \u201clife activities\u2014household\u201d (r = 0.55, p &lt; 0.01), and \u201cgetting along with people\u201d (r = 0.59, p &lt; 0.01) WHO-DAS 2.0 domains. Positive symptoms (13.89 \u00b1 3.48) correlated strongly with \u201cgetting along with people\u201d (r = 0.55, p &lt; 0.01), \u201clife activities\u2014household\u201d (r = 0.58, p &lt; 0.01), and \u201cparticipation in society\u201d (r = 0.62, p &lt; 0.01), and negative symptoms (14.25 \u00b1 4.16) with \u201cparticipation in society\u201d (r = 0.53, p &lt; 0.01) and \u201clife activities\u2014household\u201d (r = 0.48, p &lt; 0.01). Symptoms of disorganization (15.67 \u00b1 4.16) had the highest impact on \u201clife activities\u2014household\u201d (r = 0.81, p &lt; 0.01), \u201cgetting along with people\u201d (r = 0.56, p &lt; 0.05), and \u201cparticipation in society\u201d (r = 0.65, p &lt; 0.01). Episodic memory (r = \u22120.28, p &lt; 0.01) was remotely related to comprehension and communication. The information processing speed (rs = 0.38, p &lt; 0.01), visual memory (rs = \u22120.30, p &lt; 0.01), and focused executive functions showed moderate correlations with all domains on the WHO-DAS 2.0 scale (rs = 0.38, p &lt; 0.01). Attention (rs = \u22120.33, p &lt; 0.01) was moderately related to community activities. Semantic (rs = \u22120.29, p &lt; 0.01) and literal (rs = \u22120.27, p &lt; 0.01) verbal fluency demonstrated weak correlations with \u201ccognition\u2014understanding\u201d, \u201cgetting along with people\u201d, and \u201cparticipation in society\u201d. Conclusion: Symptoms of disorganization and disturbed executive functions contribute most to disability in patients with schizophrenia through impairment of real-world functioning, especially in social interactions and communication. Severe clinical symptoms (negative and disorganization-related ones) as well as deficits in executive function, verbal memory, and verbal fluency cause the biggest problems in the functional domains of interaction with other people and participation in society.<\/jats:p>","DOI":"10.3390\/ijerph20032459","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T06:06:13Z","timestamp":1675058773000},"page":"2459","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Cognitive Disturbances and Clinical Symptoms on Disability in Patients with Paranoid Schizophrenia: A Study of a Bulgarian Clinical Sample"],"prefix":"10.3390","volume":"20","author":[{"given":"Ivanka","family":"Veleva","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Medical Psychology, Faculty of Public Health, Medical University, 5800 Pleven, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7903-2387","authenticated-orcid":false,"given":"Kaloyan","family":"Stoychev","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Medical Psychology, Faculty of Public Health, Medical University, 5800 Pleven, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Stoimenova-Popova","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Medical Psychology, Faculty of Public Health, Medical University, 5800 Pleven, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Mineva-Dimitrova","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Health Management, Faculty of Public Health, Medical University, 5800 Pleven, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S0140-6736(17)32154-2","article-title":"Global, regional, andnational incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990\u20132016: Asystematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"Vos","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1093\/schbul\/sby058","article-title":"Global epidemiology and burden of schizophrenia: Findings from the global burden of disease study 2016","volume":"44","author":"Charlson","year":"2018","journal-title":"Schizophr. 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