Exploration of the experience of fatigue in schizophrenia in a psychosocial rehabilitation context

ABSTRACT Background: Fatigue is a highly prevalent and disabling symptom in schizophrenia, affecting approximately 60% of patients. Despite its impact on quality of life and rehabilitation outcomes, the lived experience of fatigue in this population remains unexplored. This qualitative study aimed to explore the lived experience of fatigue in people with schizophrenia engaged in a psychosocial rehabilitation programme, their ability to differentiate fatigue from symptoms with close constructs, and the perceived causes of fatigue. Methods: Twelve semi-structured interviews were conducted with participants with schizophrenia. Descriptive generic qualitative approach was applied, using inductive content analysis. Fatigue severity was measured using the Multidimensional Fatigue Inventory (MFI-20). Clinical assessments included the PANSS and GAF scales. Results: A total of 598 meaning units were identified and organised into three classifications: experience of fatigue, perceived causes, and differentiation from other symptoms. Fatigue manifested primarily through sensations of heaviness, effort, and need for sleep, and was described as persistent and severe (mean MFI-20 total score: 68.4 ± 16.6, 90th population percentile). Fatigue represented a major barrier to daily activities. Antipsychotic medication, schizophrenia itself, and both activity and inactivity were the most frequently cited causes for fatigue. Management strategies included energy restoration, distraction, and pacing. Participants differentiated fatigue and symptoms such as amotivation, sedation, and depression on a conceptual level, yet reported difficulties in dissociating them. Conclusion: Fatigue in schizophrenia is persistent, severe, and multidimensional, constituting a barrier to psychosocial rehabilitation. Interoceptive difficulties complexify its identification and management. Interventions combining physical activity, pacing strategies, and psychoeducation targeting fatigue catastrophism and interoceptive awareness should be investigated.