Quality of life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia

Long-acting risperidone: Focus on safety

BACKGROUND

Although atypical antipsychotics are generally regarded as having more favorable tolerability profiles than conventional antipsychotics, differences between specific atypical agents can be important when individualizing treatment. Long-acting risperidone (LAR), the first long-acting injectable atypical anti-psychotic, has been found to be effective in the treatment of schizophrenia and schizoaffective disorder.

OBJECTIVES

This review summarizes clinical evidence for the tolerability profile of LAR in patients with schizophrenia and schizoaffective disorder and assesses its utility in specific patient groups, including younger patients and the elderly.

METHODS

MEDLINE and EMBASE were searched for studies published between January 1994 and March 2006 that evaluated the tolerability of LAR. The primary search terms were long-acting risperidone, schizophrenia, schizoaffective, long term, tolerability, and safety. Abstracts and posters presented at major psychiatry and schizophrenia conferences during this period also were reviewed. Articles were included if they were reports of clinical studies and included tolerability data for LAR.

RESULTS

The literature search identified 7 open-label trials, 3 double-blind trials, 15 subanalyses, and 1 pooled analysis. When patients were switched directly or indirectly from another antipsychotic agent, LAR was generally well tolerated, with a low incidence of withdrawals due to adverse events (1%-16%). Moreover, LAR was associated with a weight-gain profile of 1 to 2 kg in the short term and did not appear to negatively affect lipids or glucose metabolism. Although LAR was associated with elevations in serum prolactin levels in 2% to 7% of patients, these elevations were not symptomatic, and levels decreased over time.

CONCLUSIONS

LAR was generally well tolerated in several patient groups, including the elderly and those with schizoaffective disorder. When patients were switched from other antipsychotics, use of LAR was not associated with an increased risk of adverse events compared with placebo.

The quality of life of people with schizophrenia living in community in Rio de Janeiro, Brazil

INTRODUCTION

The influence of sociodemographics and clinical factors on the quality of life (qol) of an individual with schizophrenia is being widely studied, particularly in developed countries. The de-institutionalization process that is taking course in Brazil, to a less symptoms-focused approach, makes necessary the assessment of the qol of these patients living in the community.

OBJECTIVES

To evaluate factors related to the qol in patients diagnosed with schizophrenia or schizo-affective disorder, and who are users of one of the two municipal community mental health services of a Rio de Janeiro district, Brazil.

MATERIAL AND METHODS

A cross-sectional study was carried out. Selected patients were interviewed with Brazilian versions of Lancashire Quality of Life Profile, Brief Psychiatric Rating Scale and Calgary Depression Scale for Schizophrenia.

RESULTS

A total of 136 patients participated in the study. Most of them were single and lived with their relatives, had low educational level, were unemployed and had low income. A great number of the interviewed did not have any social contact outside the family and leisure activity, except watching television and/or listening to the radio. Finances and work situation had the lowest satisfaction level. Educational level, presence of positive and depressive symptoms, hospital admissions were negatively associated with qol. For those receiving state benefit, perceived qol increased with age. These predictors explained more than 42% of the total subjective qol score variance.

Social cognition enhancement training for schizophrenia: a preliminary randomized controlled trial

The purpose of this study was to evaluate whether social cognition enhancement training (SCET) is effective in improving social context appraisal and perspective-taking abilities of patients with schizophrenia. A total of 34 patients were randomly assigned to receive SCET plus standard psychiatric rehabilitation training or standard psychiatric rehabilitation training only. SCET was conducted twice weekly on a group basis for 6 months. Some social cognitive abilities were improved rapidly after 2-month treatment whereas some improved only after 6-month treatment. These results show promise for the impact of SCET on the social cognitive functioning of individuals with chronic schizophrenia, and further investigation is merited.

Determinants of Changes in Perceived Quality of Life in the Course of Schizophrenia

This study aimed to identify factors that influence changes in satisfaction with quality of life (QOL) of schizophrenia patients. Baseline and follow up data for 148 schizophrenia patients were obtained at hospital admission and 16 months later. Relationships between changes over time in the general QOL index, and various factors were investigated using factor, multiple regression, and partial correlation analyses. Findings indicate that baseline levels of activation symptoms, emotional distress, task oriented coping, self-esteem and friend support together explain 41% of the variability in the general QOL index 16 months later. Changes in the general QOL of schizophrenia patients over time is associated with anergia, and paranoid symptoms, emotional distress, side effects, self-esteem, emotion and avoidance related coping styles, expressed emotion, and other social support. Determinants of change in QOL of patients were different being in hospital or out of hospital in the real world. No significant association of age, education, and follow up duration, with general QOL. Based on obtained data three types of overlapping factors were defined: (1) distressing, and protective; (2) primary and secondary; and (3) factors that remained constant or changed over time. Presented data are discussed within the framework of the Distress/Protection model of QOL. The conceptualization of three types of factors influencing QOL outcomes in this model demonstrates their predictive value, and may assist investigators and mental health workers in the interpretation of QOL data that may be used to improve patients' QOL outcomes.

Fatores associados à qualidade de vida de pacientes com esquizofrenia

OBJETIVO: O tratamento de portadores de transtornos mentais graves e crônicos tem experimentado grandes mudanças no Brasil, com uma crescente valorização de tratamentos de base comunitária. Estes pacientes passam, concomitantemente, a receber um tratamento que valoriza antes a sua reinserção social e melhora das condições de vida, do que a mera abolição de seus sintomas principais. Assim, torna-se fundamental a avaliação da qualidade de vida dos pacientes vivendo na comunidade. MÉTODO: Uma revisão bibliográfica foi realizada com o objetivo de descrever a distribuição dos fatores sociodemográficos e clínicos que influenciam a qualidade de vida de indivíduos com esquizofrenia. RESULTADOS: Foram selecionados 25 estudos, a maior parte de países europeus. A maioria foi realizada na década de 90. Quase todos os estudos eram seccionais, e a maior parte avaliou amostras de indivíduos vivendo na comunidade. Os fatores sociodemográficos, excetuando a renda mensal, não se mostraram associados à qualidade de vida. Contudo, alguns estudos encontraram associações entre gênero, idade, estado civil e escolaridade com a qualidade de vida. Os sintomas depressivos e ansiosos se mostraram associados a uma pior qualidade de vida em diversos estudos. Observou-se associação similar quanto aos sintomas negativos e positivos da esquizofrenia, mas sem a mesma consistência. CONCLUSÕES: Os estudos não foram consistentes quanto à associação entre fatores sociodemográficos e clínicos e qualidade de vida de pacientes com esquizofrenia. É possível que essa heterogeneidade de achados seja decorrente tanto de aspectos vinculados à doença quanto ao desenho desses estudos, pouco adequados à investigação de associações causais.

Patient outcomes in schizophrenia II: the impact of cognition

BACKGROUND

Cognitive dysfunction is increasingly considered to be the strongest clinical predictor of poor long-term outcome in schizophrenia. Associations have been found between the severity of cognitive deficits and social dysfunction, impairments in independent living, occupational limitations, and disturbances in quality of life (QOL).

METHODS

In this cross-sectional study, the relationships of cognitive deficits and treatment outcomes in terms of QOL, needs, and psychosocial functioning were examined in 60 outpatients with schizophrenia who had a duration of illness over 2 years and had been treated with either clozapine or olanzapine for at least 6 months.

RESULTS

The present study suggests that cognitive functioning might be a predictor of work functioning/independent living outcome in stabilized patients with schizophrenia: deficits of visual memory and working memory were negatively associated with occupational functioning, and older patients lived independently and/or in a stable partnership more often. The patients' assessments of QOL and needs for care did not show any significant associations with cognitive functioning.

DISCUSSION

These findings suggest that cognitive functioning is a key determinant of work functioning/independent living for stable outpatients with schizophrenia.

PANSS syndromes and quality of life in schizophrenia

BACKGROUND

Results from factor analysis studies have suggested that a five-dimensional structure appears to be a better representation of the psychopathological data of the PANSS. The purpose of this study was the detailed investigation of the association of schizophrenia syndromes and single symptoms with quality of life (QOL) in acute and remitted patients. The leading hypotheses were: (1) affective symptoms, especially depression and anxiety, are mostly associated with QOL longitudinally and (2) in the acute phase, QOL is also associated with positive schizophrenia symptoms.

METHODS

For the present study, schizophrenia and schizophreniform patients were studied on admission, at the end of the acute phase and 6 months after hospitalization. Psychopathology was measured using the PANSS syndromes, QOL was assessed using disease-specific (SWN) and generic (MLDL, EDLQ) scales.

RESULTS

Eighty-four patients entered the study and were assessed during the acute phase taking into account their history and actual treatment. Results revealed anxiety as the most important symptom and depression as the most important syndrome associated with different areas of QOL during and after hospitalization. Also cognitive and negative symptoms were associated with different QOL domains, but both positive symptom clusters showed no substantial association with QOL.

CONCLUSIONS

Results of this longitudinal study investigating psychopathology and QOL in schizophrenia provide further support for the need to consider the psychopathological state and treatment setting when measuring QOL in schizophrenia and the need for a differential analysis of schizophrenia symptoms and QOL in the acute, mid-term and long-term phase. Anxiety reduction should be a critical goal of treatment in order to prevent further QOL impairment.

Validity of an abbreviated quality of life enjoyment and satisfaction questionnaire (Q-LES-Q-18) for schizophrenia, schizoaffective, and mood disorder patients

We sought to identify a core subset of Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) items that maintains the validity and psychometric properties of the basic version. A parsimonious subset of items from the Q-LES-Q that can accurately predict the basic Q-LES-Q domain mean scores was sought and evaluated in 339 inpatients meeting DSM-IV criteria for schizophrenia, schizoaffective, and mood disorders. Three additional data sets were used for validation. Assessments included Q-LES-Q, Quality of Life Scale, Lancashire Quality of Life Profile, rating scales for psychopathology, medication side effects, and self-reported emotional distress, self-esteem, self-efficacy, and social support. We found that 18-items predicted basic Q-LES-Q domains (physical health, subjective feelings, leisure time activities, social relationships) and general index scores with high accuracy. Q-LES-Q-18 showed high reliability, validity, and stability of test-retest ratings. Thus, Q-LES-Q-18, a brief, self-administered questionnaire may aid in monitoring quality of life outcomes of schizophrenia, schizoaffective, and mood disorder patients.

Factors associated with low quality of life in schizophrenia

Interest in quality of life in mental health care has been stimulated by the deinstitutionalization of psychiatric patients as well as a parallel interest in understanding the scope of their daily lives. This study aims to investigate the socio-demographic and clinical variables related to low quality of life, using a cross-sectional design to evaluate quality of life by means of the QLS-BR scale. We interviewed a sample of 123 outpatients from a reference mental health center in Divinópolis, Minas Gerais State, Brazil, clinically diagnosed with schizophrenia. Univariate and multivariate logistic regression analyses were carried out. The results showed that low quality of life is associated with one or more of the following: male gender, single marital status, low income plus low schooling, use of three or more prescribed psychoactive drugs, psychomotor agitation during the interview, and current follow-up care. The study identifies plausible indicators for the attention and care needed to improve psychiatric patient treatment.

Assessing health-related quality of life in patients suffering from schizophrenia: a comparison of instruments

OBJECTIVE

To compare three different kinds of health-related quality of life (HRQL) questionnaires available for use in patients suffering from schizophrenia: the SF-36 (a generic instrument), the QoLI (an instrument designed to a broad range of mental illnesses), the S-QoL (a questionnaire specific to schizophrenic patients), in terms of external validity and sensitivity to change.

METHODS

Two hundred and five patients were included at D0 and one-third retested at D30. Socio-demographic data and clinical history were recorded, clinical evaluation comprised psychotic symptoms (PANSS), depression (Calgary depression scale for schizophrenia), global functioning (GAF), clinical severity (CGI), and extrapyramidal symptoms (ESRS). HRQL was assessed using the SF-36, the QoLI and the S-QoL.

RESULTS

A better agreement is observed between the SF-36 and the S-QoL than between the QoLI and the two other instruments. S-QoL and SF-36 are more strongly correlated with clinical status than QoLI. Compared to the SF-36 and the QoLI, the S-QoL better discriminates patients with comorbidity from others. The S-QoL shows better responsiveness than the QoLI and the SF-36.

CONCLUSION

For descriptive purpose, either generic tools like SF-36 or specific ones should be used, whereas when aiming at evaluating health treatment and care for schizophrenic patients, specific instruments like the S-QoL should be favoured.

Is adolescent-onset first-episode psychosis different from adult onset?

OBJECTIVE

To examine whether first-episode psychosis patients with onset during adolescence (ages 15-18) differ significantly from those with young-adult onset (ages 19-30).

METHOD

Consecutive patients presenting with first-episode psychosis (N = 242) were assessed for demographic and illness characteristics such as duration of untreated psychosis, diagnosis, length of prodromal period, premorbid adjustment, level of psychotic, negative, depressive, anxiety, and extrapyramidal symptoms, and alcohol and drug use.

RESULTS

Eighty-two patients (40.8%) had an onset of psychosis during adolescence (ages 15-18) and 119 (59.2%) during young adulthood (ages 19-30). The adolescent-onset group experienced longer delays in treatment of psychosis (duration of untreated psychosis) (p < .02), showed modestly worse premorbid functioning during late adolescence (p < .05), and were more likely to present with bizarre behavior (p < .01) and primary negative symptoms (p < .01).

CONCLUSIONS

Patients with adolescent onset of psychosis are more likely to present with clinical characteristics that portend a poorer outcome and may require a different approach to early identification and treatment.

Validation of a subjective quality of life questionnaire (S.QUA.LA) in schizophrenia

We developed and validated a self-administered questionnaire (Subjective Quality of Life Analysis, S.QUA.L.A.) to measure subjective quality of life. S.QUA.L.A. is a multidimensional instrument. This scale includes 22 domains of life. It covers traditional areas (food, family relation etc)., and more abstract aspects of life (politic, justice, freedom, truth, beauty and art, love). For each domain, patients are asked to evaluate their degree of satisfaction. They have also to indicate how important this domain is for them. We questioned 92 patients with schizophrenia and 357 para-medical students. The research demonstrated reproducibility, high internal consistency reliability, and sensitivity to change. Principal components analysis with varimax rotation was performed. A five-factor solution was selected, showing a great contribution of different dimensions of the self. Determinants of quality of life were identified by using correlations with Lehman's Quality of Life Interview (QOLI), and with measures of psychopathology and social functioning. Satisfaction approach and QOLI showed the same construct. We confirmed the influence of symptoms of depression and anxiety on subjective quality of life assessment, and the poor impact of disease parameters.

Relationships between demographic variables and quality of life in a population of Dutch adult psychiatric outpatients

BACKGROUND

Examinations of the role of demographic characteristics in quality of life (QOL) in psychiatric samples are not new. However, serious limitations of previous research have been that (1) QOL was not assessed according to current recommendations, (2) assessment of QOL was often hampered by a substantial overlap in content between symptoms and QOL measures, and (3) the majority of the study samples had quite specific characteristics hampering the generalizability of results, as a result of which clinical implications of the results remained unclear. The aim of the present study was to investigate explicitly the relationships between demographics and QOL in a sample reflecting the general population of psychiatric outpatients, QOL being assessed in a comprehensive, culturally sensitive, and subjective way, paying attention to the relative importance of its various facets. The main hypothesis was that these relationships would be rather weak.

METHOD

From a population of 533 adult Dutch psychiatric outpatients, 495 participants completed the World Health Organization Quality of Life (WHOQOL)-Bref for assessing QOL. Furthermore, several demographic characteristics were recorded.

RESULTS

Statistically significant correlations were found between partner relationship, habitual status, work, and sick leave and the WHOQOL-Bref domains social relationships and environment. Psychological health was associated to partner relationship, educational level, and sick leave. The total amount of QOL variance explained by demographics was rather low.

CONCLUSION

Amongst factors determining QOL, demographic characteristics are relatively unimportant. Therefore, paying attention to demographics during psychiatric treatment will probably have little effect on improvement of QOL.

Quality of life and temperament factors in schizophrenia: comparative study of patients, their siblings and controls

This study aimed to determine which temperament factors are associated with quality of life (QOL) in schizophrenia based on a triplet design comparing patients with their non-affected siblings and healthy control subjects. Forty-seven DSM-IV clinically stable schizophrenia outpatients, 47 non-affected siblings, and 56 non-patients matched for gender and age were evaluated using the Tridimensional Personality Questionnaire and the Quality of Life Enjoyment and Life Satisfaction Questionaire. As expected, schizophrenia patients reported significantly poorer QOL in most specific domains and in general. They also revealed significantly higher scores on harm avoidance and scored lower on reward dependence, than both their siblings and controls. Tridimensional Personality Questionnaire temperament factors revealed no differences between the controls and the siblings. When differences between patients, their siblings and controls were adjusted for gender, age at examination, and education, ANOVA demonstrated that temperament factors contributed to poor satisfaction with physical health, social relationships and subjective feelings in schizophrenia patients. Harm avoidance was associated with general QOL independent of severity of psychopathology. Thus, this study suggests that temperament factors that are not necessarily part of the deterioration process of the illness are associated with the quality of life of schizophrenia patients. These and other non-illness related factors should be considered when evaluating quality of life outcomes in intervention studies.

Condensed version of the Quality of Life Scale for schizophrenia for use in outcome studies

The Quality of Life Scale (QLS(21)) is widely used in clinical trials involving schizophrenia patients. This study aimed to identify a core subset of QLS(21) items that maintains the validity and psychometric properties of the complete version. A parsimonious subset of items from the QLS(21) that can accurately predict the total scale score was sought and evaluated in 133 schizophrenia patients, using the heuristic algorithm for a regression model. Two additional data sets were used for model validation: a subset of 124 patients who participated in the model construction and who completed the QLS(21) 1 year later as well as a new sample of 40 inpatients. Patients were examined with the Positive and Negative Syndrome Scale (PANSS), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Talbieh Brief Distress Inventory (TBDI), the Extrapyramidal Symptom Rating Scale (ESRS) and the Global Assessment of Functioning Scale (GAF). Using only five QLS items (social initiatives, adequacy, acquaintances, motivation, and time utilization; QLS(5)) as predictors, the correlation was 0.9805 between the predicted and true QLS totals. Two validation samples confirmed this finding. Additional analyses indicate that the QLS(5) exhibited similar performance to the QLS(21) regarding construct validity, test-retest reliability and responsiveness to changes over time. Thus, the five-item condensed Quality of Life Scale for schizophrenia maintains the validity of the full QLS, and has the advantage of shorter administration time. Utilization of the revised QLS(5) in routine care and clinical trials may potentially facilitate evaluation of treatment outcomes in schizophrenia.

Quality of life outcomes of risperidone, olanzapine, and typical antipsychotics among schizophrenia patients treated in routine clinical practice: a naturalistic comparative study

Findings in previous studies investigating the beneficial effect of risperidone and olanzapine versus typical antipsychotics on quality of life (QOL) are controversial since they did not adjust for various factors contributing to QOL. To test this assumption in a naturalistic cross-sectional design, we evaluated general and domain-specific QOL scores for baseline data of schizophrenia outpatients stabilized on atypical (N = 78, risperidone or olanzapine) and typical (N = 55) agents. Self-report and observer-rated QOL outcomes of both risperidone and olanzapine with typical antipsychotic therapy were compared across demographic, illness-related, and treatment-related factors using analysis of variance, multivariate analysis of variance, and correlation analysis. No significant differences were found in QOL outcomes of risperidone-treated and olanzapine-treated patients. Both self-report and rater-observed QOL measures indicated superiority of atypical over typical antipsychotic agents after adjusting for daily doses, duration of treatment, subjective tolerability, and adjuvant antidepressants. Lower daily doses and longer antipsychotic treatment were associated with better QOL. Self-report and observer-rated QOL scores correlated positively (r = 0.64, P < 0.001). Gender, marital status, age, education, living arrangement and employment status, age of onset, illness duration, symptom severity, emotional distress, subtypes of schizophrenia, and side effects did not affect QOL outcomes in either group. Risperidone and olanzapine revealed an advantage over typical agents in terms of QOL. Findings suggest that when calculating the beneficial effects of atypical antipsychotic therapy on QOL outcomes, daily doses, duration of treatment, and subjective tolerability may be intervening variables and should be adjusted accordingly to clearly appreciate benefits of atypical antipsychotics.

Current issues in schizophrenia: overview of patient acceptability, functioning capacity and quality of life

The increasing interest in the subjective wellbeing and quality of life (QoL) of patients with schizophrenia represents a conceptual extension of therapeutic outcome criteria. For a long time, the reduction of positive symptoms alone was the most important outcome parameter, but the development of atypical antipsychotic drugs in the early 1990s resulted in the adoption of more wide-reaching measures of therapeutic outcome. Patient satisfaction appears to be strongly related to their willingness to be or stay engaged in psychosocial and pharmacological treatment, and therefore to the symptomatic and functional outcome. Existing studies that deal with QoL and subjective wellbeing differ in their methodology and are difficult to compare because of varying underlying concepts of QoL or subjective wellbeing, different assessment scales or small sample sizes. Although QoL is a heterogeneous concept, it is clearly correlated with a number of factors, including illness, medication and stress process-related variables. Various protective factors have been identified; among these are personality traits, the degree of social support and treatment interventions. In clinical studies, atypical antipsychotic agents are associated with greater improvements in QoL and subjective wellbeing than are conventional agents. The reason for this is probably the ability of atypical agents to have a positive impact on factors most associated with QoL, such as negative and affective symptoms and drug tolerability. The most appropriate clinical approach to maximize QoL and subjective wellbeing for patients with schizophrenia is to use atypical antipsychotic drugs as a first-line treatment approach. Ideally, an atypical drug which is known not to have a negative effect on attention, affect or motivation should be chosen.

Tardive Dyskinesia Risks and Metoclopramide Use Before and After U.S. Market Withdrawal of Cisapride

OBJECTIVE

To assess risk factors for tardive dyskinesia (TD) in spontaneous reports of metoclopramide and TD and evaluate metoclopramide prescribing patterns before and after withdrawal of cisapride from the market in the United States.

DESIGN

Retrospective and observational analyses.

SETTING

International metoclopramide adverse event reports and domestic drug-use data for the continental United States.

PATIENTS

Users of metoclopramide for 30 days or more who experienced adverse events reported as TD.

INTERVENTIONS

Analyses of the Food and Drug Administration Adverse Event Reporting System (AERS) and IMS HEALTH data.

MAIN OUTCOME MEASURES

Pharmacoepidemiological patterns in AERS reports and utilization data from IMS HEALTH.

RESULTS

The case series comprised 87 reports of primarily older (mean+/-SD, 60+/-22 years ) women (67% of all cases). While average metoclopramide daily dose (33+/-14 mg) was within recommended product labeling limits, duration of use was considerably longer (753+/-951 days). Overall, 37% of the reports included concomitant drugs believed to be TD risk factors. Similarly, 18% of the reports noted comorbid diseases that are considered risk factors for development of TD. Metoclopramide utilization decreased following cisapride marketing in 1993 and increased following cisapride withdrawal in 2000. The majority (62%) of metoclopramide prescriptions were intended for women. Intended use overall increased with age and was highest in the seventh and eighth decades, with nearly one quarter of all utilization being in persons older than 70 years.

CONCLUSION

Well-described TD risk factors were common in metoclopramide-associated TD reports. Given the cisapride market withdrawal and associated increased metoclopramide utilization, the incidence of TD may increase accordingly. TD risk factors relative to the intended benefit and duration of use should be considered in metoclopramide prescribing.

Quality of life in schizophrenics with and without the deficit syndrome

We investigated the relations between deficit as part of schizophrenic symptomatology and the popular but unclear concept of quality of life (QOL). In a 47-patient sample, subjective QOL was compared in schizophrenics with and without the deficit syndrome. Self- and hetero-rated QOL is more impaired in deficit patients. Differences between deficit and non-deficit groups are more significant as the index used for measuring QOL gets less "behavioral" and more "psycho-pathological". These results are consistent with existing literature. The "behavioral" dimensions of Heinrichs' quality of life scale (QLS) are less discriminative between deficit and non-deficit schizophrenics, but they are more independent of the symptoms. They might have a special clinical meaning, which needs to be defined. The concepts of QOL (as used in QLS) and deficit symptomatology are partially redundant. QLS might be an inappropriate, or at least un-specific measure of QOL.

Quality of life of schizophrenic psychiatric outpatients as a criterion for treatment planning in psychiatric institutions

BACKGROUND

Subjective quality of life (QoL) is an indispensable part of the current concept of health. Therefore it should serve as a criterion for treatment planning in social psychiatric institutions.

AIM

We looked at the QoL of our outpatients diagnosed with schizophrenia in order to identify possible areas of life that might need further attention in treatment planning.

METHODS

We used the short German version of the Lancashire Quality of Life Profile (BLEP-KF) to evaluate the QoL of 164 schizophrenic outpatients. All patients were diagnosed with the International Diagnostic Checklists (IDCL) for ICD-10. Demographic and treatment data are analysed cross-sectionally in relation to their QoL.

RESULTS

The majority of patients was moderately happy with their general QoL. They were least satisfied in the domains of job and financial situation, mental health and sexuality. Psychopathology and especially the quality of individual care had a significant influence on the evaluation of QoL.

CONCLUSION

This result supports an argument in favour of more individual patient-centred forms of case management to reduce the burden of severe psychopathological symptoms experienced in everyday activities by patients suffering from schizophrenia.

Quality of life in persons with schizophrenia in out-patient treatment with first- or second-generation antipsychotics

OBJECTIVE

Effects of first in comparison with second-generation antipsychotics on the subjective quality of life (QoL) of patients with schizophrenia under routine treatment conditions were examined.

METHOD

In a prospective naturalistic trial the QoL, social, clinical, and treatment-related characteristics and type of antipsychotic medication of 307 patients with schizophrenia (ICD-10 F 20) were assessed five times with 6-month intervals over 2.5 years. Longitudinal and cross-sectional effects of antipsychotic medication were assessed by hierarchical regression models. Selection bias was controlled by propensity scores.

RESULTS

While positive effects of first-generation antipsychotics on subjective QoL in comparison with no antipsychotic treatment were found, second-generation antipsychotics caused no better QoL than first-generation antipsychotics.

CONCLUSION

The hypothesis that second-generation in comparison with first-generation antipsychotics have a better effect on the improvement of subjective QoL of people with schizophrenia in routine out-patient treatment was not supported.

Can patients at risk for persistent negative symptoms be identified during their first episode of psychosis?

Patients with schizophrenia who show persistent negative symptoms are an important subgroup, but they are difficult to identify early in the course of illness. The objective of this study was to examine characteristics that discriminate between first-episode psychosis (FEP) patients in whom primary negative symptoms did or did not persist after 1 year of treatment. Patients with a DSM-IV diagnosis of FEP whose primary negative symptoms did (N = 36) or did not (N = 35) persist at 1 year were contrasted on their baseline and 1-year characteristics. Results showed that patients with persistent primary negative symptoms (N = 36) had a significantly longer duration of untreated psychosis (p < .005), worse premorbid adjustment during early (p < .001) and late adolescence (p < .01), and a higher level of affective flattening (p < .01) at initial presentation compared with patients with transitory primary negative symptoms. The former group also showed significantly lower remission rates at 1 year (p < .001). Multiple regression analysis confirmed the independent contribution of duration of untreated psychosis, premorbid adjustment, and affective flattening at baseline to the patients' likelihood of developing persistent negative symptoms. It may therefore be possible to distinguish a subgroup of FEP patients whose primary negative symptoms are likely to persist on the basis of characteristics shown at initial presentation for treatment.

Quality of life of clients with schizophrenia

BACKGROUND

Because of the deinstitutionalization of mental health care in Hong Kong that has taken place since the 1980s, many people with mental health problems are being cared for in the community. The majority of clients have a diagnosis of schizophrenia, and many have a long duration of illness and multiple readmissions. There is concern about their quality of life.

AIM

To investigate quality of life and related factors in clients with a diagnosis of schizophrenia in Hong Kong.

DESIGN

A convenience sample was recruited from a psychiatric outpatient department. Structured face-to-face interviews were conducted using the Brief Psychiatric Rating Scale and the Hong Kong Chinese World Health Organization Quality of Life Scale-Brief Version.

RESULTS

A total of 172 people participated in the study. Most of them were single and unemployed. They were least satisfied with their psychological health, financial situation, life enjoyment and sexual activity. Women (n = 91) reported less satisfaction with quality of life than men (n = 86). Unemployed people (n = 100) were less satisfied with their quality of life than the employed (n = 76). Higher levels of mental health problems and higher numbers of previous hospitalizations were associated with negative perceptions of quality of life.

DISCUSSION

People with mental health problems had significantly less satisfaction with their quality of life than a sample from the general population in Hong Kong surveyed in a previous study. As well as experiencing distressing mental symptoms, they had many difficulties, such as financial problems, unemployment and lack of opportunities to participate in social activities, that resulted from stigma and discrimination. These had a great impact on their quality of life.

STUDY LIMITATIONS

Because of the small sample size and its convenience nature, the findings may not be generalizable to all clients in Hong Kong. A generic instrument was used to measure quality of life, and this may not have been sensitive to certain aspects of mental health clients' lives.

CONCLUSION

The findings suggest that there is a need to strengthen social and vocational rehabilitation for people with mental health problems in Hong Kong. A more holistic and intensive model of care is required to meet their complex needs. A larger and more diverse sample should be used in future research, and a quality of life measure specifically designed for people with mental health problems should be used.

The sensitivity of quality-of-life scale WHOQOL-100 to psychopathological measures in schizophrenia

We aimed to investigate the reliability and the clinical sensitivity of the World Health Organization Quality of Life (WHOQOL-100) scale for patients diagnosed with schizophrenia because of its multilingual, multidimensional, and cross-cultural properties. Fifty-four stabilized outpatients with schizophrenia and 49 age-, sex-, and occupation-matched healthy control subjects were recruited. The scale showed high internal consistency (Cronbach alpha = 0.94). While there was no correlation between total scores of psychopathology measures (Brief Psychiatric Rating Scale [BPRS], Scale for the assessment of Negative Symptoms [SANS], Scale for the Assessment of Positive Symptoms [SAPS], and Clinical Global Impression [CGI]), significant negative correlations were obtained especially between subscales of the BPRS, SANS, SAPS, and QOL domains. Stepwise multiple regression analysis also revealed that the BPRS anxiety/depression and SANS anhedonia subcales were the predictor variables in five of six QOL domains in the schizophrenia group. The better quality-of-life scores of the mild group on physical and psychological domains indicate that the WHOQOL-100 could be used as an outcome measure in clinical studies. Thus, the WHOQOL-100 scale is a reliable, subjective quality-of-life scale for patients diagnosed with schizophrenia. The clinical sensitivity should also be assessed in large follow-up studies.

Quetiapine, clozapine, and olanzapine in the treatment of tardive dyskinesia induced by first-generation antipsychotics: a 124-week case report

Our report of a patient with severe tardive dyskinesia (TD) who has been exposed to both typical antipsychotic and clozapine, olanzapine and quetiapine during a 124-week follow-up period supports the possible beneficial effect of atypical antipsychotics on pre-existing symptoms of TD. Persistently high AIMS scores during all the periods of treatment with typical antipsychotics contrast strongly with the drop in scores that occurs in strict chronological sequence after switching to both clozapine (45%), olanzapine (27.8%) and quetiapine (85%). Since the reversal to haloperidol from the three atypical agents was systemically associated with a return to high AIMS scores, it seems likely that the improvement noted with clozapine, olanzapine and quetiapine represents a temporary symptomatic effect rather than a sustained resolution of the disorder. The olanzapine-clozapine-quetiapine rank order of increasing effectiveness against TD symptoms suggests that this property, although shared by the atypical antipsychotics, is to some degree drug-specific. Patient- and/or drug-dependent mechanisms may be involved in this gradient of effect.

Life satisfaction and suicidal attempts among persons with schizophrenia

The relationship between subjective quality of life (QOL) and suicide attempts in patients with schizophrenia has been understudied. The current study tested the hypothesis that QOL is negatively associated with a history of suicidality of patients with schizophrenia. QOL, as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), was investigated in 227 inpatients with DSM-IV diagnosis of schizophrenia with and without a lifetime history of suicide attempts. The statistical analysis included analysis of variance (ANOVA), t tests, and analysis of covariance (ANCOVA). The patients who had attempted suicide multiple times were less satisfied with regard to a larger number of life domains than the nonattempters and the single attempters. The differences in QOL remained significant after adjusting for psychiatric history and current psychopathology variables, e.g., age of onset of the disorder, number and length of hospitalizations, and positive, negative, and depressive symptoms. Dissatisfaction with QOL in general and with reference to four specific domains was associated with repeated suicide attempts. Clinicians should include QOL in the evaluation of patients with schizophrenia that are suspected to be suicidal.

Depression and subjective quality of life in chronic phase schizophrenic patients

OBJECTIVE

To evaluate the influence of depression on subjective quality of life in schizophrenic patients.

METHOD

Sixty-seven schizophrenic patients in a stabilized phase were included. Schizophrenic symptoms were evaluated using the Positive and Negative Symptoms Scale (PANSS). The subjective quality of life was evaluated using the short version of the Lehman quality of life scale (QoLI). Depression was evaluated using the Calgary Depression Scale for Schizophrenia (CDSS) and extrapyramidal effects with the Extrapyramidal Symptoms Rating Scale (ESRS).

RESULTS

The PANSS total score, PANSS general psychopathology subscore, PANSS depression factor, the total CDSS and some ESRS scores were negatively correlated with the overall life satisfaction score. The CDSS score was negatively correlated with all except one QoLI score. QoLI scores were significantly lower in depressed patients, and this result remained consistent for four QoLi dimensions when adjusted on ESRS and PANSS scores. When analysing the association between high depression scores and high parkinsonism scores with reduced quality of life, multivariate analysis showed that depression was the main explanatory factor: the CDSS total score explained 22% of the variance of the overall subjective quality of life score. The patient questionnaire at the ESRS explained 10.5% of the variance of the 'mental and physical health' QoLI score.

CONCLUSION

In schizophrenic patients, depressive symptoms should be focused because of their strong association to overall subjective quality of life.

Satisfaction with quality of life varies with temperament types of patients with schizophrenia

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.

A longitudinal study of patient- and observer-rated quality of life in schizophrenia

Patient-rated life satisfaction and observer-rated quality of life (ORQOL) appear to have different determinants in patients with schizophrenia, although most studies conducted to date have used cross-sectional methods or related clinical dimensions at one time point with quality of life (QOL) measured at another. The aim of this study was to investigate the relationship between changes in patient-rated QOL (PRQOL) and ORQOL over time and changes in clinical variables. Two hundred and thirty-one patients taking part in the Schizophrenia Care Assessment Program (SCAP) study at Dandenong in Australia were included in this analysis. Subjective ratings of several domains of social functioning and life satisfaction were taken from the SCAP instrument and comparisons made with data from the QOL Scale rated by research staff, as well as several psychopathology measures. Changes in these scores over 1 year were correlated to investigate relationships between measures. Weak correlations were seen between changes in PRQOL and ORQOL domains. Patient-rated domains related most closely to depressive symptoms (Montgomery-Asberg Depression Rating Scale scores) whereas observer-rated domains related to both negative symptoms and depressive symptoms. Positive psychotic symptoms had little effect on either domain. Longitudinal data appear to confirm that PRQOL and ORQOL are not closely related and may have differing determinants in patients with schizophrenia. They should be considered as separate and complementary outcome variables and utilized accordingly.

Reliability and validity of Quality of Life assessed by the Short-Form 36 and the Modular System for Quality of Life in patients with schizophrenia and patients with depression

Reliability and validity of the Quality of Life (QoL) construct were investigated in healthy controls (N=346), patients with depression (N=114) and patients with schizophrenia (N=91) using two different QoL instruments: the Short-Form 36 (SF-36), a well-established generic instrument measuring eight dimensions; and the Modular System for Quality of Life (MSQoL), a recently developed instrument measuring seven core dimensions and four specific modules (objective data, partnership, family, occupation). The MSQoL and the SF-36 were administered at three intervals (hospital admission, discharge and 4-month follow-up). Reliability, group profiles (clinical specificity), responsiveness, discriminant validity (with regard to sociodemographic, psychopathological, clinical and state variables) and convergent validity were tested. At admission, patients with depression had the lowest QoL level, patients with schizophrenia had an intermediate level, and controls had the highest QoL level. At discharge and follow-up, the two patient groups did not differ from each other, but still had lower levels than controls. Both patient groups improved significantly in QoL from admission to discharge. This improvement was confounded by improvement in depressive symptoms, but not in positive or negative symptoms. Current mood state influenced QoL assessments in all three samples substantially. In conclusion, QoL can be measured reliably and with sufficient responsiveness by the MSQoL and the SF-36 in psychiatric and non-clinical populations, although discriminant validity with regard to depression and current mood is questionable.

Pharmacological approaches to the management of schizophrenia

Pharmacological treatment remains the mainstay of the management of schizophrenia. Older, "typical" antipsychotics carry a significant burden of side effects, notably extrapyramidal and neurocognitive side effects. Newer, "atypical" agents carry a lower risk of extrapyramidal side effects. They appear to have added benefit for treating negative and cognitive symptoms of schizophrenia, and hence can enhance the quality of life of some patients. The choice of particular agents for individual patients requires a balancing of efficacy and side effects. Medication is only one element of what should be an individualised comprehensive treatment plan for people with schizophrenia.

Predicting changes in domain-specific quality of life of schizophrenia patients

The author sought to determine domain-specific quality of life (QOL) changes over time and to identify predictors of change in life satisfaction among schizophrenia patients. He assessed 148 schizophrenia inpatients at admission and 16 months later. Multiple regression analysis identified predictors of domain-specific changes in QOL from changes in psychopathology, emotional distress, side effects, insight, and stress process-related factors ratings. On the group level, satisfaction with subjective feelings and leisure activities improved significantly during the follow-up period. Individual changes in specific QOL domains are influenced by different patterns of predictors that accounted for 12% to 36% of variance. Emotional distress, paranoid symptoms, side effects, and insight inversely associated with variability of scores in domain-specific QOL. Changes in self-efficacy, self-esteem, and support from others were positively correlated to improvement in QOL domain ratings. Schizophrenia patients may experience improvement in specific QOL domains. Changes in stress process-related factors are stronger predictors of fluctuations in QOL domains than changes in illness symptoms and should be considered when evaluating life satisfaction.

Residential environment and quality of life among seriously mentally ill residents of board and care homes

This study examined the relationship between residential environment of seriously mentally ill patients living in board and care homes and quality of life. Participants included 162 seriously mentally ill veteran patients living in 26 board and care homes in Los Angeles. Data from structured interviews were used to assess subjective quality of life (satisfaction with living situation and general well-being) and objective quality of life (social functioning and daily activities). Independent variables examined in multivariate analyses included individual socio-demographic and clinical characteristics, objective characteristics of the home, and subjective resident assessments of social climate within the home. Adjusting for individual characteristics, social climate was significantly and positively associated with both satisfaction with current living situation and with general well-being. Interpersonal conflict was negatively associated with general well-being. Number of beds within the home and median income in the neighborhood were significantly associated (positively and negatively, respectively) with social functioning outside the home. Living environment characteristics explained between 3 and 9% of the total variation in three of four quality of life measures, and 27% of the variation in the fourth, satisfaction with living situation. Satisfaction with living situation among seriously mentally ill residents of board and care homes may be enhanced by making the social climate more positive, and reducing conflict within the home. Social functioning outside of the home may be enhanced by placing patients into a home with more beds, and/or a home located in a lower income neighborhood.

Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings

OBJECTIVE

To investigate the relationships between characteristics of the living situation in the community and subjective quality of life and social network among community-based individuals with schizophrenia.

METHOD

A total of 418 individuals with schizophrenia from 10 sites were interviewed with regard to quality of life, psychopathology, social network and needs for care. Characteristics of the living situation investigated were: living alone or not, living with family or not, and having an independent or a sheltered housing situation.

RESULTS

An independent housing situation was related to a better quality of life concerning living situation and living with the family to a better quality of life concerning family relations. An independent housing situation was associated with a better social network regarding availability and adequacy of emotional relations.

CONCLUSION

People with schizophrenia with an independent housing situation have a better quality of life associated with more favorable perceptions of independence, influence, and privacy. Their social network is better irrespective of whether they live alone or not, or with family or not.

Subjective quality of life in severely mentally ill patients: a comparison of two instruments

Although many quality of life (QOL) scales have been developed, comparison of specific QOL instruments is lacking. We compared the psychometric properties of two QOL measures in parallel samples of mentally disturbed and non-patient subjects. We simultaneously administered the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and self-report items of the Lancashire Quality of Life Profile (LQOLP) to 199 patients with severe mental disorders and 175 non-patients. The patients were evaluated with psychiatric rating scales. We identified five concordant domains, and five instrument-specific domains for the LQOLP and four for the Q-LES-Q. The Q-LES-Q provides better psychometric properties than the LQOLP in both samples. Both instruments show a good capacity to evaluate QOL and discriminate between the patients and non-patient controls. Within the patient sample, both QOL measures showed similarly negative correlations with severity of depression, but not mania, positive, negative, and general symptomatology. Both instruments proved to be mental health related, but neither was mental-disorder specific. Despite the acceptable psychometric properties and correlation of general QOL indices, similar QOL domains proved to be instrument specific and not sufficiently compatible. These discrepancies should be considered when comparing evaluations from similar domains in these QOL scales.

Patients' subjective experiences of antipsychotics: clinical relevance

The subjective experience of patients with schizophrenia who are receiving antipsychotic medication has been a neglected research area, as has the satisfaction of patients with their drug treatments. This is unfortunate, as satisfaction with treatment appears to be related strongly to the readiness of patients to take their medication as prescribed, and thereby to outcome. Patients' perceptions of their treatment do not appear to be related strongly to severity of illness or symptom ratings, although there are associations between perceptions of treatment and adverse effects. Surveys of patient experience with typical antipsychotics have tended to indicate high levels of dissatisfaction and perceived adverse effects. There have been a number of surveys of patients' perceptions of treatment with the atypical antipsychotics. These tend to accord with the expectation that a relative freedom from adverse effects with the atypical antipsychotics will be reflected in enhanced levels of satisfaction and perceived well-being. In general, these studies share a number of weaknesses, including small sample sizes, bias in selection of respondents, open treatment and lack of suitable comparator groups. In addition, many have adopted a cross-sectional, rather than longitudinal, approach and have relied on nonvalidated and perhaps idiosyncratic rating measures. Recently, there have been studies of better methodological quality. These, too, have indicated that patients regard the newer treatments more positively than the older regimens. In addition, there is now evidence that the various new-generation antipsychotics may be evaluated differently by patients.

Quality of life and standard of living in a randomly selected group of psychiatrically disabled people in Sweden 2 years after a psychiatry reform

In Sweden, a psychiatry reform, aimed at improving the living conditions of the psychiatrically disabled, came into force in 1995. The aim of the present study was to evaluate the impact of the reform by investigating quality of life and standard of living 2 years later in a randomly selected group of people with longstanding psychiatric disability. Self-ratings and interviews were conducted in a study group and a control group. The study group consisted of 19 women and 18 men (mean age 46.1 years) diagnosed with neurosis, schizophrenia or affective disorder. The control group consisted of 19 women and 17 men (mean age 48.7 years). Self-rated quality of life was significantly poorer in the study group (P < 0.0001, unpaired t-test), and so was housing (P < 0.001, test of similar proportions in independent samples). We found no significant positive correlation between subjective quality of life and standard of living in either group but a significant negative correlation in the control group (P < 0.05; r = 0.40, Pearson correlation coefficient). The results suggest that, in 1997, people with longstanding psychiatric disability still had poorer quality of life than the general population. This may be due to factors other than outward standard of living.

Negative symptoms in first episode non-affective psychosis

OBJECTIVE

To determine the prevalence of negative symptoms and to examine secondary sources of influence on negative symptoms and the role of specific negative symptoms in delay associated with seeking treatment in first episode non-affective psychosis.

METHOD

One hundred and ten patients who met Diagnostic Statistical Manual-IV (DSM-IV) criteria for a first episode of schizophrenia spectrum psychoses were rated for assessment of negative, positive, depressive and extrapyramidal symptoms, the premorbid adjustment scale and assessment of demographic and clinical characteristics including duration of untreated psychosis (DUP).

RESULTS

Alogia/flat affect and avolition/anhedonia were strongly influenced by parkinsonian and depressive symptoms, respectively. A substantial proportion (26.8%) of patients showed at a least moderate level of negative symptoms not confounded by depression and Parkinsonism. DUP was related only to avolition/anhedonia while flat affect/alogia was related to male gender, diagnosis of schizophrenia, age of onset and the length of the prodrome.

CONCLUSION

Negative symptoms that are independent of the influence of positive symptoms, depression and extra pyramidal symptoms (EPS) are present in a substantial proportion of first episode psychosis patients and delay in seeking treatment is associated mainly with avolition and anhedonia.

Quality of life in schizophrenia: a review of the literature from 1995 to 2000

The measurement of the quality of life of patients diagnosed with psychiatric disorders has become central to evaluating the effectiveness of treatments offered by Australian mental health services. The importance of quality of life as an indicator of the outcomes of interventions has been reflected by a large body of research seeking to measure the impact of variables such as gender, ethnicity and duration of illness on the measurable quality of life of an individual diagnosed with schizophrenia. This study aims to review and synthesize the recent literature in which quality of life has been measured by the use of at least one quality of life instrument. It is concludes that while the measurement of quality of life is valuable as a measure of outcomes, it should be treated as only one means of doing so.

Quality of life in patients with schizophrenia in five European countries: the EPSILON study

OBJECTIVE

To compare subjective quality of life (QOL) and objective QOL indicators in patients with schizophrenia from five European sites: Amsterdam, Copenhagen, London, Santander and Verona.

METHOD

A representative sample of 404 patients with schizophrenia, in contact with mental health services, was randomly selected and evaluated with the Lancashire Quality of Life Profile (EU).

RESULTS

The level of satisfaction in certain domains, religion, family and social relations appears to be associated with local style of living and culture while work, finances, and safety were more independent from local variations. In addition to the severity of symptoms, frequency of contacts with family, friendship and age appear as predictors of QOL, all of them influenced by the characteristics of the surroundings.

CONCLUSION

The centres participating in the study presented differences in subjective measures of QOL, objective indicators and also in service provision and styles of living.

Predictors of improvement in quality of life of long-term mentally ill individuals receiving case management

One hundred and thirteen long-term mentally ill clients receiving case management were investigated with regard to psychosocial and clinical predictors of changes in subjective quality of life during an 18-month follow-up. Better psychosocial functioning and fewer psychiatric symptoms at baseline predicted a greater improvement in quality of life. A larger decrease in symptom severity and a greater improvement in the social network during the follow-up were identified as the most important predictors of a greater improvement in subjective quality of life. The results of the study suggest that an emphasis should be put on effective symptom management, a reduction of needs for care and social support in order to fulfill the aims of improving subjective quality of life in patients receiving case management.

The relationship of personality dimensions as measured by the temperament and character inventory and quality of life in individuals with schizophrenia or schizoaffective disorder living in the community

The influence of personality factors on the appraisal of subjective quality of life in individuals with schizophrenia or schizoaffective disorder is not much investigated. The present study examined this relationship in a sample of 104 patients living in the community. The temperament and character inventory was used to assess personality and the Lancashire quality of life profile was used to assess quality of life. The results showed that lower levels of harm avoidance and higher levels of self-directedness were significantly correlated to a better subjective quality of life. Regression analyses controlling for psychopathology revealed that a higher level of self-directedness was significantly associated with a better subjective quality in all aspects measured and explained the variance in the latter in the range of 4-12%. It is concluded that personality factors are involved in severely mentally ill individuals' assessment of their quality of life and should be accounted for in evaluations of quality of life assessments. The strength and directions of this influence require further studies.

The relationship of personality dimensions as measured by the temperament and character inventory and quality of life in individuals with schizophrenia or schizoaffective disorder living in the community

The influence of personality factors on the appraisal of subjective quality of life in individuals with schizophrenia or schizoaffective disorder is not much investigated. The present study examined this relationship in a sample of 104 patients living in the community. The temperament and character inventory was used to assess personality and the Lancashire quality of life profile was used to assess quality of life. The results showed that lower levels of harm avoidance and higher levels of self-directedness were significantly correlated to a better subjective quality of life. Regression analyses controlling for psychopathology revealed that a higher level of self-directedness was significantly associated with a better subjective quality in all aspects measured and explained the variance in the latter in the range of 4-12%. It is concluded that personality factors are involved in severely mentally ill individuals' assessment of their quality of life and should be accounted for in evaluations of quality of life assessments. The strength and directions of this influence require further studies.

Subjective quality of life in schizophrenic outpatients in a Catalan urban site

The aim of this cross-sectional study was to assess the subjective quality of life of chronic schizophrenic outpatients living in an urban site in Catalonia (Spain) during a stable phase of the illness. We included 44 patients with a DSM-IV diagnosis of psychotic disorder. Sociodemographic, clinical, and treatment variables were obtained and compared with the subjective quality of life as assessed by the Lehman Quality of Life Interview-short version. The descriptive analysis of the subjective quality of life profile obtained in our sample shows moderate levels of satisfaction in most subscales. Results regarding comparisons showed that sociodemographic, clinical, premorbid adjustment and treatment variables were only related to subjective quality of life in particular life domains and in a nonconclusive way. The need to include other relevant variables such as insight or psychological traits in the study of the quality of life phenomenon in schizophrenia is highlighted.

Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor

We examined the relationships among changes in anxiety, depression, core symptoms of schizophrenia, and subjective quality of life (QL) longitudinally. Fifty-three stabilized outpatients diagnosed with schizophrenia or schizoaffective disorder were assessed for QL and symptoms every 3 months for a period of 1 year. Using mixed effects models, we found that changes in anxiety, as rated on the Brief Psychiatric Rating Scale, were inversely associated with general life satisfaction and satisfaction with many specific domains. These relationships were stronger than the relationships of QL and any other core symptoms of schizophrenia, including depression. Anxiety was also related to some positive and negative symptoms. These findings support the notion that more precise analysis of general psychopathology, and anxiety in particular, is important in clarifying the factors involved in QL in schizophrenia. We explain our findings in the context of current theories of affect and suggest implications for the treatment of schizophrenia.

Quality of life in schizophrenia: contributions of anxiety and depression

A number of studies have demonstrated a strong relationship between quality of life in schizophrenia and general psychopathology measures, and moreover, that the positive, negative, and disorganized symptoms are less related to quality of life. The current investigation examined the relationship between quality of life and symptomatology in 63 stabilized outpatients diagnosed with schizophrenia or schizoaffective disorder. Consistent with other findings, more severe depression, as rated on the Brief Psychiatric Rating Scale (BPRS) was associated with lower general life satisfaction and lower satisfaction with daily living, finances, health, and social life. In addition, higher anxiety ratings on the BPRS were associated with less satisfaction with global quality of life, daily activities, family, health and social relationship, even when controlling for positive symptoms, negative symptoms, or depression. No other symptoms of schizophrenia were as strongly associated with subjective quality of life. Anxiety was also significantly correlated with a number of positive and negative symptoms while depression was substantially less related. These findings, suggest that more precise analyses of general psychopathology, and anxiety in particular, may be necessary to further clarify the factors involved in quality of life in schizophrenia. In addition, these findings suggest future directions for theories of affect and treatment in schizophrenia.

Impact of phase-specific treatment of first episode of psychosis on Wisconsin Quality of Life Index (client version)

OBJECTIVE

The objective of this study was to assess the impact of a phase-specific community-focused treatment program on different dimensions of self-reported quality of life in a representative sample of first episode psychosis patients.

METHOD

Data were collected on patients presenting with a first episode of psychosis on the Wisconsin Quality of Life Index (client version), positive and negative symptoms, and demographic and clinical variables at baseline following clinical stabilization and at 1 year.

RESULTS

Complete data on a representative sample of 41 patients showed a significant improvement in most dimensions of the WQOL at 1 year; these changes were generally independent of changes in symptoms and there were no significant differences in the magnitude of improvement in QOL between those with DUP < or >6 months.

CONCLUSION

Patients with a first episode of predominantly schizophrenia spectrum psychosis show a highly significant improvement in subjectively assessed quality of life following a year of phase-specific comprehensive treatment.