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Sampogna G, Di Vincenzo M, Giuliani L, Menculini G, Mancuso E, Arsenio E, Cipolla S, Della Rocca B, Martiadis V, Signorelli MS, Fiorillo A. A Systematic Review on the Effectiveness of Antipsychotic Drugs on the Quality of Life of Patients with Schizophrenia. Brain Sci 2023; 13:1577. [PMID: 38002537 PMCID: PMC10669728 DOI: 10.3390/brainsci13111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the "best" treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients' quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients' clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients' cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Salvatore Cipolla
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
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Ishii Y, Tomotake M, Chiba S, Tsutsumi R, Aono M, Taguchi K. Relationship between quality of life and clinical factors in inpatients with schizophrenia. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:80-85. [PMID: 35466151 DOI: 10.2152/jmi.69.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to clarify the relationship between quality of life (QOL) and clinical factors in inpatients with schizophrenia. METHODS Subjects were 50 hospitalized patients with schizophrenia. Their mean age was 56.48 (Standard Deviation=11.93) years. Japanese version of the schizophrenia Quality of Life Scale (JSQLS) and Subjective Well-being under Neuroleptic drug Treatment Short form, Japanese version (SWNS-J) were used to assess subjective QOL, and Mini Mental State Examination-Japanese was used to evaluate cognitive function. Japanese version of the Calgary Depression Scale for Schizophrenia (JCDSS), Brief Psychiatric Rating Scale, and Drug-Induced Extrapyramidal Symptoms Scale were used to assess depression severity, psychotic symptoms, and drug-induced extrapyramidal symptoms, respectively. Stepwise regression analyses were conducted to find factors influencing JSQLS and SWNS-J. RESULTS JCDSS was a predictor of two scales of JSQLS, and JCDSS also predicted SWNS-J Total and it's two subscales. However, other clinical factors were not related to JSQLS and SWNS-J. CONCLUSION The results indicate that treating depressive symptoms may lead to improvement of subjective QOL in inpatients with schizophrenia. J. Med. Invest. 69 : 80-85, February, 2022.
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Affiliation(s)
| | - Masahito Tomotake
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shinichi Chiba
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Rie Tsutsumi
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masatomo Aono
- Department of psychiatry, Jounan Hospital, Tokushima, Japan
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Kølbæk P, Thorgaard MV, Grooss AS, Selvanathan T, Larsen SF, Speed M, Dines D, Østergaard SD. Clinical validation of the Aarhus Side effect Assessment Questionnaire(ASAQ). J Psychopharmacol 2022; 36:507-515. [PMID: 35234056 DOI: 10.1177/02698811221077196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychotropic medications are essential in the treatment of mental illness. Unfortunately, these medications are associated with side effects that may reduce adherence to treatment and quality of life. Therefore, systematic screening for side effects is fundamental to optimize treatment with psychotropic medications. Self-report of side effects is a practical alternative to time-consuming clinical assessments. We developed the Aarhus Side effect Assessment Questionnaire (ASAQ) in an attempt to strike the balance between extensive coverage of side effects and reasonable application time. AIM The aim of the study was to validate the ASAQ using the clinician-rated Udvalg for Kliniske Undersøgelser (UKU) Side Effect Scale as gold standard reference. METHODS A total of 122 inpatients and outpatients-mainly with psychotic (39%) and affective disorders (43%)-receiving treatment with psychotropic medication completed the ASAQ and the World Health Organization-Five Well-Being Index (WHO-5) and were subsequently rated on the UKU by trained raters. RESULTS Using the UKU as the gold standard reference, the ASAQ demonstrated sensitivity values >75% for 77% of its 30 items (ranging from 37% for cutaneous disturbances to 98% for increased sweating) and specificity values >75% for 47% of its 30 items (ranging from 28% for reduced sleep to 98% for micturition disturbances). While 17% of the participants considered discontinuing their medication, 24% had recently refrained from taking their medication as prescribed. A negative correlation was found between the ASAQ and the WHO-5 and total scores (Pearson's correlation coefficient = -0.44). CONCLUSIONS The self-reported ASAQ seems to be a sensitive tool for detecting side effects of psychotropic medications.
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Affiliation(s)
- Pernille Kølbæk
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Mette Viller Thorgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | | | - Thusitha Selvanathan
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Sofie Fly Larsen
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Maria Speed
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - David Dines
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
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Heller MK, Chapman SCE, Horne R. Beliefs About Medicines Predict Side-Effects of Placebo Modafinil. Ann Behav Med 2022; 56:989-1001. [PMID: 35512392 DOI: 10.1093/abm/kaab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients receiving placebo in clinical trials often report side-effects (nocebo effects), but contributing factors are still poorly understood. PURPOSE Using a sham trial of the cognition-enhancing "smart pill" Modafinil we tested whether medication beliefs and other psychological factors predicted detection and attribution of symptoms as side-effects to placebo. METHODS Healthy students (n = 201) completed measures assessing beliefs about medication, perceived sensitivity to medicines, negative affectivity, somatization, and body awareness; 66 were then randomized to receive Deceptive Placebo (told Modafinil-given placebo, 67 to Open Placebo (told placebo-given placebo, and 68 to No Placebo. Memory and attention tasks assessed cognitive enhancement. Nocebo effects were assessed by symptom checklist. RESULTS More symptoms were reported in the Deceptive Placebo condition (M = 2.65; SD = 2.27) than Open Placebo (M = 1.92; SD = 2.24; Mann-Whitney U = 1,654, z = 2.30, p = .022) or No Placebo (M = 1.68; SD = 1.75, Mann-Whitney U = 1,640, z = 2.74, p = .006). Participants were more likely to attribute symptoms to Modafinil side-effects if they believed pharmaceuticals to be generally harmful (incidence rate ratio [IRR] = 1.70, p = .019), had higher perceived sensitivity to medicines (IRR = 1.68, p = .011), stronger concerns about Modafinil (IRR = 2.10, p < .001), and higher negative affectivity (IRR = 2.37, p < .001). CONCLUSIONS Beliefs about medication are potentially modifiable predictors of the nocebo effect. These findings provide insight into side-effect reports to placebo and, potentially, active treatment.
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Affiliation(s)
- Monika K Heller
- Centre for Behavioural Medicine, UCL School of Pharmacy, UCL, Tavistock Square, WC1H 9JP, London, UK
| | - Sarah C E Chapman
- Centre for Behavioural Medicine, UCL School of Pharmacy, UCL, Tavistock Square, WC1H 9JP, London, UK.,Department of Pharmacy & Pharmacology, University of Bath, Claverton Down Road, Bath, UK
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, UCL, Tavistock Square, WC1H 9JP, London, UK
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Rekhi G, Tay J, Lee J. Impact of drug-induced Parkinsonism and tardive dyskinesia on health-related quality of life in schizophrenia. J Psychopharmacol 2022; 36:183-190. [PMID: 34979813 DOI: 10.1177/02698811211055812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Both drug-induced Parkinsonism (DIP) and tardive dyskinesia (TD) have been shown to be associated with lower health-related quality of life (HRQOL) in schizophrenia, but few studies have examined their relative impact. AIMS This study aimed to examine and compare the association of DIP and TD with HRQOL in schizophrenia. METHODS In total, 903 patients with schizophrenia were assessed on the Positive and Negative Syndrome Scale (PANSS), Simpson-Angus Scale (SAS), and Abnormal Involuntary Movement Scale (AIMS). EuroQoL five-dimensional (EQ-5D-5L) utility scores were derived from PANSS scores via a previously validated algorithm and used as a measure of HRQOL. RESULTS In total, 160 (17.7%) participants had only DIP, 119 (13.2%) had only TD, and 123 (13.6%) had both DIP and TD. HRQOL was lowest for participants with both DIP and TD, followed by only DIP group, only TD group, and highest in the group with neither condition. HRQOL scores differed significantly between the four groups, F(3, 892) = 13.724, p < 0.001, ηp2 = 0.044). HRQOL of participants having only DIP or both DIP and TD was significantly lower than those having neither condition. There was no significant interaction between the presence of DIP and TD on the association with HRQOL. CONCLUSIONS DIP was the main antipsychotic-induced movement disorder associated with a poorer HRQOL in patients with schizophrenia. Therefore, clinicians should focus on prevention, detection, and effective management of DIP to optimize HRQOL in patients with schizophrenia.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore
| | - Jenny Tay
- Research Division, Institute of Mental Health, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore.,North Region & Department of Psychosis, Institute of Mental Health, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Cox AD, Virues-Ortega J. Long-term functional stability of problem behavior exposed to psychotropic medications. J Appl Behav Anal 2021; 55:214-229. [PMID: 34329500 DOI: 10.1002/jaba.873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/06/2022]
Abstract
Psychopharmacological and behavioral interventions are often combined in the treatment of problem behavior in people with intellectual and developmental disability (IDD). However, little is known about the interaction between medication pharmacodynamics and behavior function. A better understanding of these mechanisms could serve as the conceptual foundation for combined interventions. The current analysis is a systematic replication of Valdovinos et al. (2009). We conducted continuous functional analyses within analogue reversal and parametric analyses monitoring the impact of various dosages of primarily antipsychotic medications on problem behavior and its function. Four individuals with IDD and problem behavior who were also receiving psychotropic medications participated. Medication adjustments produced small to negligible decreases in problem behavior, and behavior function remained largely unchanged through the 14 medication adjustments evaluated. The continuous functional analysis helped to identify what could be delayed medication effects on problem behavior. The clinical and methodological implications of this replication are discussed.
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Affiliation(s)
| | - Javier Virues-Ortega
- Universidad Autónoma de Madrid, Madrid, Spain.,The University of Auckland, Auckland, New Zealand
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Delamillieure P, Ochoa-Torres D, Vasse T, Brazo P, Gourevitch R, Langlois S, Assouly-Besse F, Van Der Elst A, Morello R, Guelfi J, Petit M, Dollfus S. The subjective quality of life in deficit and nondeficit schizophrenic patients. Eur Psychiatry 2020; 20:346-8. [PMID: 16018928 DOI: 10.1016/j.eurpsy.2005.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Revised: 01/18/2005] [Accepted: 04/20/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractWe assessed the subjective quality of life (QOL) of 30 deficit schizophrenic patients compared to 112 nondeficit schizophrenic patients. The deficit patients did not differ in term of QOL, total score of positive symptoms, general psychopathology from the nondeficit patients. This result suggested an absence of impact of primary negative symptoms on the subjective QOL in schizophrenic patients.
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Affiliation(s)
- Pascal Delamillieure
- Centre Esquirol, Centre Hospitalier et Universitaire, avenue côte de nacre, 14000 Caen, France
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Quality of life in schizophrenia: Long-term follow-up in 362 chronic Spanish schizophrenic outpatients undergoing risperidone maintenance treatment. Eur Psychiatry 2020; 13:158-63. [DOI: 10.1016/s0924-9338(98)80141-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
SummaryOur aim was to determine the effect of risperidone monotherapy treatment on disability and on the quality of life of 318 schizophrenic outpatients who had been previously treated with other neuroleptics. Patients were assessed at baseline 2, 4 and 8 months using the BPRS, CGI, WHO/DDS and SF-36. BPRS scores showed a significant decrease at month 2, both in the total score and in each of the three clusters, negative, positive and depression/anxiety. WHO/DDS scores significantly decreased both in the overall score (from 51.8 to 37.4, P < 0.0001) and in the four dimensions. SF-36 scale scores and summary measures showed a significant improvement after 8 months of risperidone treatment. Risperidone long-term treatment (8 months) has a positive effect on clinical and on psychosocial outcomes. Females, paranoids patients and patients without history of use-abuse of substances showed greater improvements in quality of life.
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Grover S, Sahoo S, Bn S, Malhotra N, Dua D, Avasthi A. Attitude and perceptions of patients towards long acting depot injections (LAIs). Asian J Psychiatr 2019; 44:200-208. [PMID: 31419737 DOI: 10.1016/j.ajp.2019.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the well-established efficacy of the long acting depot injectable (LAIs) antipsychotics, these are significantly underused and underutilized by the mental health professionals, with a belief that patients will not accept the same. AIMS & OBJECTIVES To explore the acceptability and perception of patients towards various psychiatric treatments, with specific focus on LAIs. Additionally the study aimed to compare the acceptability of various types of treatments including LAIs between patients with severe mental disorders (Psychotic disorders and Bipolar disorder) and those with Common mental disorders (Anxiety, neurotic and depressive disorders). METHODOLOGY A self-designed semi-structured questionnaire was used to evaluate the preferred treatment options of all the new patients attending the psychiatry outpatient clinic of a tertiary care hospital. Depending on the response, they were further probed for the reasons for accepting or rejecting the LAIs. RESULTS 2659 patients were interviewed who were divided into two groups (Group I - 321 subjects with psychotic disorders and 120 subjects with bipolar affective disorder (BPAD) and Group II - 2218 subjects with neurotic, stress-related and unipolar depressive disorders). More than three-fourth (78.8%) of the participants in the whole study sample opted for tablets only as their first preferred choice and injectables were opted by about 5% of the participants only, with no significant difference between the 2 groups. After being explained about LAIs, one fourth of the participants (24.9%) reported that they may consider LAIs, without any significant difference between the 2 groups. Among those who refused to take LAIs even after explanation, the commonly reported reasons were difficulty in visiting hospital frequently for the injectables (41.69%), injectables being painful (19.41%), fear of injections (13.96%), no need to take LAIs (12.45%) and preference to take some other types of medicines (8.52%). CONCLUSIONS Considering the fact that LAIs are highly underused in patients with severe mental disorders and there is lack of awareness about LAIs among patients with severe mental disorders, the present study findings suggest that there is reasonable level of acceptance of LAIs among patients with severe mental disorders when explained about the same.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subodh Bn
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Nidhi Malhotra
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, Sector-32, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Widschwendter CG, Kemmler G, Rettenbacher MA, Yalcin-Siedentopf N, Hofer A. Subjective well-being, drug attitude, and changes in symptomatology in chronic schizophrenia patients starting treatment with new-generation antipsychotic medication. BMC Psychiatry 2018; 18:212. [PMID: 29954366 PMCID: PMC6022409 DOI: 10.1186/s12888-018-1791-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/12/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Non-adherence to medication remains a major challenge in the long-term management of patients with schizophrenia. Next to lack of insight into the illness, adverse effects of antipsychotic drugs, cognitive deficits, poor therapeutic alliance, reduced quality of life, missing social support, and negative attitudes toward medication are predictors of non-adherence. This study examined potential correlations between attitudes toward antipsychotic drug therapy, subjective well-being, and symptom change in patients with chronic schizophrenia. METHODS 30 patients with schizophrenia starting monotherapy with a new-generation antipsychotic were included into the study. The Drug Attitude Inventory (DAI) and the Subjective Well-being under Neuroleptic Treatment Scale, short form (SWN-K), were administered after 2, 4, and 12 weeks of treatment. At the same points in time and at baseline, psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS), and functioning was assessed by means of the Global Assessment of Functioning Scale (GAF). Antipsychotic induced side effects were evaluated by using the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale. RESULTS Study participants had a mean age of 37.5 ± 9.7 years, baseline symptoms were mild. The PANSS total score improved significantly from baseline to weeks 4 (p = .003) and 12 (p = .001), respectively. Neither the DAI total score nor the SWN-K total score changed significantly over the course of time. The severity of symptoms was not correlated with drug attitude at any time point but was negatively correlated with wellbeing at weeks 2 (r = -.419, p = .021) and 4 (r = -.441, p = .015). There was no significant correlation between DAI and SWN-K total scores at any time point. CONCLUSIONS Next to showing that the DAI and the SWN-K measure different aspects of subjective experiences during antipsychotic treatment these findings emphasize the use of both instruments to optimize adherence to medication.
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Affiliation(s)
- Christian G. Widschwendter
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Georg Kemmler
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Maria A. Rettenbacher
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Nursen Yalcin-Siedentopf
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Alex Hofer
- 0000 0000 8853 2677grid.5361.1Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020 Innsbruck, Austria
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Sum MY, Tay KH, Sengupta S, Sim K. Neurocognitive functioning and quality of life in patients with and without deficit syndrome of schizophrenia. Psychiatry Res 2018; 263:54-60. [PMID: 29499447 DOI: 10.1016/j.psychres.2018.02.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 02/02/2018] [Accepted: 02/12/2018] [Indexed: 11/15/2022]
Abstract
Deficit syndrome of schizophrenia is a subtype of schizophrenia characterized by primary and enduring negative symptoms. This study examined the differences in neurocognitive functioning and quality of life (QOL) between deficit and non-deficit patients, and specific predictors of both clinical measures. Overall, 344 subjects (175 patients with non-deficit schizophrenia (NDSZ), 58 patients with deficit schizophrenia (DSZ) and 111 healthy controls) were evaluated on severity of psychopathology, QOL and a smaller subset of 198 subjects (104 NDSZ, 27 DSZ, 67 healthy controls) underwent neurocognitive assessments. Multivariate analyses were used to determine differences in outcomes between subject groups and predictors of clinical measures. Both DSZ and NDSZ had significantly worse QOL compared with healthy controls. DSZ had more extensive cognitive deficits compared with healthy controls and performed worse on semantic fluency task compared to NDSZ. Multiple linear regression analysis found that DSZ, shorter duration of illness were associated with poorer QOL whereas fewer years of education, lower premorbid intelligence were associated with poorer overall neurocognitive functioning. The poorer QOL, greater extent of neurocognitive deficits especially semantic fluency associated with DSZ behoves the need for greater attention during clinical evaluation and treatment planning of this subgroup of individuals with schizophrenia.
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Affiliation(s)
- Min Yi Sum
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| | - Kai Hong Tay
- Department of General Psychiatry, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| | - Somnath Sengupta
- Department of General Psychiatry, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore
| | - Kang Sim
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore; Department of General Psychiatry, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, 539747, Singapore.
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Abstract
PURPOSE OF REVIEW To provide an overview of a selection of largely neglected psychological risk factors for nonadherence, and to offer new approaches to improve medication adherence. RECENT FINDINGS Current adherence research and intervention programs focus on a few risk factors for nonadherence, such as complexity of the drug regimen. In addition, other important risk factors of nonadherence are neglected or insufficiently addressed. There is good evidence for the significant role of the quality of the patient-healthcare provider relationship. Other risk factors like the individual history of nonadherence, the lack of acceptance of having a treatable disorder, fear of side-effects, comorbid depression, and cognitive impairment have been broadly neglected in adherence programs, although they offer a powerful key to improve adherence-oriented interventions. SUMMARY Current research on determinants of nonadherence has focused on a few risk factors, while neglecting crucial psychological predictors of nonadherence. The personalized consideration of a multiplicity of risk factors offers a new basis for the development and evaluation of interventions to better promote adherence.
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Comparison of Subjective Experiences and Effectiveness of First-Generation Long-Acting Injectable Antipsychotics and Risperidone Long-Acting Injectables in Patients With Schizophrenia. J Clin Psychopharmacol 2016; 36:492-5. [PMID: 27580495 DOI: 10.1097/jcp.0000000000000555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted a cross-sectional study to compare the subjective experiences and clinical effects of first-generation long-acting injectable (FGA-LAI) antipsychotics with those of risperidone long-acting injectables (RIS-LAIs) in 434 schizophrenia patients. Compared with the RIS-LAI group, the patients treated with FGA-LAIs had a significantly longer duration of illness and LAI treatment and were older. Our results suggest that patients treated with FGA-LAI have more satisfactory subjective experiences compared with patients treated with RIS-LAI and that both FGA-LAI and RIS-LAI treatments can prevent relapses and hospitalization. Additional longitudinal studies determining the long-term benefits of RIS-LAI are warranted.
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Tomotake M, Kaneda Y, Iga JI, Kinouchi S, Tayoshi S, Motoki I, Sumitani S, Yamauchi K, Taniguchi T, Ishimoto Y, Ueno SI, Ohmori T. Subjective and Objective Measures of Quality of Life Have Different Predictors for People with Schizophrenia. Psychol Rep 2016; 99:477-87. [PMID: 17153817 DOI: 10.2466/pr0.99.2.477-487] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the relationship between subjective and objective quality of life and assessed predictors in people with schizophrenia. The study population consisted of 99 stabilized outpatients with schizophrenia (DSM-IV) who had been regularly receiving outpatient treatment at the Department of Psychiatry, The Tokushima University Hospital. Subjective and objective quality of life were estimated using the Schizophrenia Quality of Life Scale and the Quality of Life Scale, respectively. Psychiatric symptoms were also measured with the Brief Psychiatric Rating Scale and the Calgary Depression Scale for Schizophrenia. Scores on the Schizophrenia Quality of Life Scale Motivation and Energy scales significantly correlated with the Quality of Life Scale total scores –.40 ( p <.001), and with the scores on Interpersonal Relations subscale –.42 ( p <.001), Instrumental Role subscale –.28 ( p = .005), Intrapsychic Foundations subscale –.39 ( p <.001), and Common Objects and Activities subscale –.25 ( p = .014). The Schizophrenia Quality of Life Scale Psychosocial scale significantly correlated with only the Quality of Life Scale total score –.20 ( p = .05), and there was no significant correlation between the scores on the Schizophrenia Quality of Life Scale Symptoms and Side-effects scales and the Quality of Life Scale. Stepwise regression analyses showed that the Calgary Depression Scale for Schizophrenia score was the most important predictor of each scale of the Schizophrenia Quality of Life Scale, and the Brief Psychiatric Rating Scale Negative Symptoms score was the most important predictor of the Quality of Life Scale total score and each subscale. These results suggest that subjective and objective quality of life have different predictors and should be considered as separate and complementary outcome variables.
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Affiliation(s)
- Masahito Tomotake
- Department of Psychiatry, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushimashi, Tokushima 770-8503, Japan.
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15
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Stomski NJ, Morrison P, Meehan T. Mental health nurses' views about antipsychotic medication side effects. J Psychiatr Ment Health Nurs 2016; 23:369-77. [PMID: 27353448 DOI: 10.1111/jpm.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The only previous quantitative study that examined nurses' use of assessment tools to identify antipsychotic medication side effects found that about 25% of mental health nurses were using assessment tools. No previous studies have examined factors that influence the manner in which mental health nurses assess antipsychotic medication side effects. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: One-third of the respondents were not aware of any antipsychotic medication side-effect assessment tool, and only one-quarter were currently using an assessment tool. 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools, indicating that respondents with more positive attitudes to their service were more likely to continue using antipsychotic medication assessment tools. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The low level of awareness and use of antipsychotic medication side-effect assessment tools indicates that nursing educational institutions should incorporate more detail about these tools in course content, and emphasize in particular the benefits that result from the use of these tools in clinical practice. Service processes contributed significantly to the use of antipsychotic medication assessment tools, which indicates that managers need to foster workplace cultures that promote routine use of these tools. ABSTRACT Introduction Limited evidence suggests that only a minority of mental health nurses regularly use standardized assessment tools to assess antipsychotic medication side effects, but the factors that contribute to the non-routine use of these tools remain unknown. Aim To examine Australian mental health nurses' awareness of, and attitudes towards, side-effect assessment tools, and also identify factors the influence the use of these tools. Methods A cross-sectional survey was undertaken through distributing an online questionnaire via email to members of the Australian College of Mental Health Nurses. Completed questionnaires were received from 171 respondents. Linear regression was used to examine the relationship between the 'service responsibility' and 'personal confidence' scale scores, and awareness, previous use and ongoing use of antipsychotic medication assessment tools. Results Only one-quarter of the respondents (26.5%) were currently using an assessment tool. 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools (Β = 3.26; 95% CI 0.83-5.69). 'Personal confidence' did not influence the ongoing use of assessment tools (Β = -0.05; 95% CI -1.06-1.50). Implications for clinical practice Stakeholders can incorporate 'service responsibility' processes to foster increased use of assessment tools, which may enhance the identification antipsychotic medication side effects and improve the quality of care for service users.
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Affiliation(s)
- N J Stomski
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - P Morrison
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - T Meehan
- School of Medicine, University of Queensland, Richlands, QLD, Australia
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Comparative Safety of Pharmacologic Treatments for Persistent Depressive Disorder: A Systematic Review and Network Meta-Analysis. PLoS One 2016; 11:e0153380. [PMID: 27187783 PMCID: PMC4871495 DOI: 10.1371/journal.pone.0153380] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
We aimed to compare the safety of antidepressants for the treatment of persistent depressive disorder (PDD) with each other and with placebo. We conducted a systematic electronic search and included randomized controlled trials that investigated antidepressants for the treatment of PDD in adults. Outcomes were the incidence of experiencing any adverse event, specific adverse events and related treatment discontinuations. We analyzed the data using traditional and network meta-analyses. Thirty-four studies that comprised 4,769 patients and examined 20 individual agents in nine substance classes were included. Almost all analyzed substance classes were associated with higher discontinuation rates than placebo including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), antipsychotics, and the serotonin antagonist and reuptake inhibitor (SARI) trazodone. The odds of experiencing any adverse event were significantly higher for TCAs and serotonin noradrenaline reuptake inhibitors (SNRIs) compared to placebo. Pairwise comparisons among the substance classes revealed that more patients receiving TCAs or SNRIs experienced any adverse event and that more patients receiving TCAs or the SARI trazodone discontinued treatment. The complementary treatment with acetyl-l-carnitine showed lower rates of experiencing any adverse event and related discontinuations than all other comparators. TCAs were primarily associated with (anti-)cholinergic and sedating adverse events. SSRIs primarily showed gastrointestinal adverse events. Patients treated with the antipsychotic amisulpride were more likely to manifest weight gain and endocrine adverse events. The comparative evidence for further agents was insufficient or lacking. The identified safety differences may be used to inform the selection among the antidepressants.
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17
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Abstract
Taking into account findings in the literature, the author aimed to test whether specific graphical characteristics of handwriting can distinguish patients diagnosed with schizophrenic disorders from healthy controls. Handwriting samples (one sample from each person) from 60 outpatients (29 women, 31 men; age M = 28.5, SD = 5.4) with paranoid schizophrenia were analyzed by three documents examiners and were compared to samples from 60 controls (30 men, 30 women, age M = 28.0, SD = 3.0) without psychiatric disorders. Document examiners assessed 32 graphical features potentially related to schizophrenia. The comparisons between groups revealed that only 7 out of 32 handwriting properties were significantly different in the handwriting of schizophrenic outpatients from controls: the calligraphic forms of letters, loops in ovals, lacking of dots, tremor, sinusoidal baseline, and irregularities size of lower zone. These findings are discussed in terms of motor disturbances in schizophrenia and in relation to the previous research on handwriting of other mental disorders. Similarities between the graphical patterns of handwriting of schizophrenic patients and those of other mental disorders and/or other mental states have been demonstrated.
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Affiliation(s)
- Barbara Gawda
- Department of Psychology, Maria Curie-Sklodowska University, Lublin, Poland
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18
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The longitudinal trends in the relationship between drug-induced extrapyramidal symptoms and personal and social performance in a population of the patients with schizophrenia: A latent growth model. Psychiatry Res 2016; 238:33-39. [PMID: 27086208 DOI: 10.1016/j.psychres.2016.01.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/17/2015] [Accepted: 01/28/2016] [Indexed: 11/22/2022]
Abstract
The aim of this study was to explore the longitudinal trends in the relationship between personal and social functioning and drug-induced extrapyramidal symptoms (DIEPS). The baseline sample included 484 patients with schizophrenia. Participants were assessed at baseline, weeks 4 (time 2), 8 (time 3), and 12 (time 4) regarding social functioning, and DIEPS. In latent growth analysis, the path coefficient between the intercept for the DIEPSS and the intercept for the PSP indicated a significant cross-sectional relationship between these two variables. And the path coefficient between the intercept of the DIEPSS and the slope of the PSP was also significant, indicating that patients who initially had more serious side effects tended to exhibit less improvement in their personal and social functioning over time. Similarly, a significant path coefficient between the slopes of the two variables indicated a dynamic and possibly reciprocal association over time. In addition, K-PSP scale showed good construct validity and reliability. Based on the standardized PSP scale, our results demonstrate DIEPSS induced by antipsychotic treatment dynamically affect personal and social functioning over time, a negative association between psychosocial aspects and the DIEPS.
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Avieli H, Mushkin P, Araten-Bergman T, Band-Winterstein T. Aging With Schizophrenia: A Lifelong Experience of Multidimensional Losses and Suffering. Arch Psychiatr Nurs 2016; 30:230-6. [PMID: 26992876 DOI: 10.1016/j.apnu.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
The aim of this study was to explore the subjective experience of suffering in aging individuals with schizophrenia. Qualitative interviews were conducted with 18 participants aged 60-69. Phenomenological content analysis was performed. Nine dimensions of suffering emerged: social rejection; familial rejection; the symptoms of schizophrenia; hospitalisation; the side effects of medication; loss of employment potential; loss of independent accommodation; loss of social life, and loss of hope to be a partner and a parent. The suffering of aging people with schizophrenia is cumulative and ongoing and thus evokes issues such as existential loneliness and feelings of homelessness.
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Affiliation(s)
- Hila Avieli
- Department of Criminology, Ariel University; Department of Gerontology, University of Haifa
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Meister R, von Wolff A, Mohr H, Nestoriuc Y, Härter M, Hölzel L, Kriston L. Adverse event methods were heterogeneous and insufficiently reported in randomized trials on persistent depressive disorder. J Clin Epidemiol 2016; 71:97-108. [DOI: 10.1016/j.jclinepi.2015.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022]
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Heller MK, Chapman SCE, Horne R. Beliefs about medication predict the misattribution of a common symptom as a medication side effect--Evidence from an analogue online study. J Psychosom Res 2015; 79:519-29. [PMID: 26519128 DOI: 10.1016/j.jpsychores.2015.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Some perceived medication side effects may be 'normal' symptoms that patients misattribute to the medication. Using an analogue approach, we tested if medication beliefs predict whether participants misattribute a headache as a side effect and subsequently intend to stop medication. METHODS We recruited 690 participants, 223 reporting a past asthma diagnosis. They received information about asthma and Molair, a fictitious asthma treatment modeled on a licensed treatment (montelukast). We varied the description of efficacy and side effects (which did not include headache). Pre-exposure to this information, participants completed the Beliefs about Medicine Questionnaire (BMQ)-General and the Perceived Sensitivity to Medicines Scale (PSM), post-exposure they completed the BMQ-Specific. Participants were asked to imagine they experienced a headache while taking Molair. Finally, they rated whether the headache was a side effect (misattribution) and if they would stop taking Molair (behavioral intention). RESULTS Nearly a quarter (170) of participants misattributed the headache to Molair and 69 (10%) subsequently intended to stop Molair. Both outcomes were predicted by general and specific medication beliefs. Odds of misattribution (m) and behavioral intention (i) increased with higher General Harm (ORm=1.90, ORi=2.72), General Overuse (ORm=1.74, ORi=1.56) and Molair Concern beliefs (ORm=1.52, ORi=1.78, all p<.01), but decreased with General Benefit (ORm=0.72, ORi=0.53) and Molair Necessity beliefs (ORm=0.72, ORi=0.70, all p<.05). CONCLUSION Symptom misattribution and subsequent intentions to stop Molair were predicted by pre-exposure beliefs about medicines in general and post-exposure beliefs about Molair. Patients with negative medication beliefs may be prone to misattribute symptoms and subsequently stop medication.
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Affiliation(s)
- Monika K Heller
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, United Kingdom
| | - Sarah C E Chapman
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, United Kingdom
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, United Kingdom.
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22
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Cox AD, Virues-Ortega J. Interactions between behavior function and psychotropic medication. J Appl Behav Anal 2015; 49:85-104. [DOI: 10.1002/jaba.247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 03/03/2015] [Indexed: 11/09/2022]
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Park T, Hadsall RS, Schommer JC, Gross CR, Rector TS, Davison ML. Development of an adverse-event coping scale (AECS) using item response theory. Res Social Adm Pharm 2015; 11:651-63. [PMID: 25592190 DOI: 10.1016/j.sapharm.2014.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adverse drug events (ADEs) cause significant morbidity and mortality to patients. A brief questionnaire asking patients how they coped with such problems could be a useful tool for providing timely interventions. OBJECTIVE The aim of this study was to develop an adverse-event coping scale (AECS) to measure patients' coping responses to their ADE. METHODS Data were collected from subjects recruited from community pharmacies. Psychometric analyses based on item response theory (IRT) were performed to calibrate items and assess reliability. Convergent validity was evaluated by testing a priori formulated hypotheses about expected correlations between the coping scores and other related scales. RESULTS A total of 140 patients participated in this study by answering the developed items. Confirmatory factor analysis supported a one-dimensional item bank with 11 items. The developed scale was reliable with the reliability coefficient of 0.82. Coping scores were positively correlated with seriousness of the ADE and health literacy, but not coping self-efficacy. Overall, results suggest that the score reflects problem magnitude and coping effort rather than coping efficacy. CONCLUSION A high score on the AECS indicates an ADE serious enough to prompt a patient to invest substantial efforts to cope with it. The final AECS item bank and its short-form can help clinicians better understand their patients' ADE-coping efforts.
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Affiliation(s)
- Taehwan Park
- Pharmacy Administration, St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, USA.
| | - Ronald S Hadsall
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jon C Schommer
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Cynthia R Gross
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Thomas S Rector
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
| | - Mark L Davison
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN 55455, USA
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Liu L, Ma X, Zhao X. What do psychotic experiences mean to Chinese schizophrenia patients? QUALITATIVE HEALTH RESEARCH 2012; 22:1707-1716. [PMID: 23034777 DOI: 10.1177/1049732312460589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this study we explored the perceptions of Chinese patients with schizophrenia about their treatment, mental state, social relationships, and daily life throughout the psychotic episodes. A purposive sample of 16 schizophrenia patients with heterogeneous demographic backgrounds was recruited. We collected data through face-to-face semistructured interviews. We conducted a qualitative data analysis and identified three central themes inductively: (a) negative experiences, (b) sense of powerlessness, and (c) ambivalent therapeutic relationship. Several subthemes were derived under each central theme. The participants' narratives revealed a complex picture of disadvantage and difficulties throughout their psychotic episodes and rehabilitation processes. The themes identified are explored in detail, and their links with existing research and potential clinical implications are considered.
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Affiliation(s)
- Liang Liu
- Shanghai Jiao Tong University, Shanghai, China
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25
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Rossi G, Frediani S, Rossi R, Rossi A. Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations. BMC Psychiatry 2012; 12:122. [PMID: 22909285 PMCID: PMC3573926 DOI: 10.1186/1471-244x-12-122] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 08/01/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs). This review aims to describe the demographic and clinical characteristics of the ideal profile of the patient with schizophrenia treated with LAIs, through the analysis of nonrandomized studies. METHODS A systematic review of nonrandomized studies in English was performed attempting to analyze the factors related to the choice and use of LAIs in daily practice. The contents were outlined using the Cochrane methods for nonrandomized studies and the variables included demographic as well as clinical characteristics. The available literature did not allow any statistical analysis that could be used to identify the ideal profile of patients with schizophrenia to be treated with LAIs. RESULTS Eighty publications were selected and reviewed. Prevalence of LAI use ranged from 4.8% to 66%. The only demographic characteristics that were consistently assessed through retrieved studies were age (38.5 years in the 1970's, 35.8 years in the 1980's, 39.3 years in the 1990's, to 39.5 years in the 2000's) and gender (male > female).Efficacy was assessed through the use of various symptom scales and other indirect measurements; safety was assessed through extrapyramidal symptoms and the use of anticholinergic drugs, but these data were inconsistent and impossible to pool. Efficacy and safety results reported in the different studies yielded a good therapeutic profile with a maximum of 74% decrease in hospital admissions and the prevalence of extrapyramidal symptoms with LAIs consistently increased at 6, 12, 18, and 24 months (35.4%, 37.1%, 36.9%, and 41.3%, respectively). CONCLUSIONS This analysis of the available literature strongly suggests that further observational studies on patients with schizophrenia treated with LAIs are needed to systematically assess their demographic and clinical characteristics and the relationships between them and patient outcome.Besides the good efficacy and safety profile of LAIs, health care staff must also take into account the importance of establishing a therapeutic alliance with the patient and his/her relatives when selecting the most appropriate treatment. LAIs seem to be a good choice not only because of their good safety and efficacy profile, but also because they improve compliance, a key factor to improving adherence and to establishing a therapeutic alliance between patients with schizophrenia, their relatives, and their health care providers.
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Affiliation(s)
- Giuseppe Rossi
- U.O. Psichiatria, IRCCS "Centro San Giovanni di Dio" Fatebenefratelli, via Pilastroni 4, Brescia, Italy.
| | - Sonia Frediani
- Centro di Salute Mentale La Badia U.S.L. 11, Empoli, Italy
| | - Roberta Rossi
- U.O. Psichiatria, IRCCS “Centro San Giovanni di Dio” Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Andrea Rossi
- Medical Dept. Eli Lilly Italy, Via Gramsci 731, Sesto Fiorentino (FI), Italy
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Hsiao CY, Hsieh MH, Tseng CJ, Chien SH, Chang CC. Quality of life of individuals with schizophrenia living in the community: relationship to socio-demographic, clinical and psychosocial characteristics. J Clin Nurs 2012; 21:2367-76. [DOI: 10.1111/j.1365-2702.2012.04067.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The aim of this study was to assess Chinese schizophrenia patients' quality of life (QOL) and identify its demographic and clinical correlates. A random sample of 540 community-dwelling schizophrenia patients was interviewed using standardized assessment instruments. The patients' basic sociodemographic and clinical data and QOL were collected. Compared with the general population, patients had significantly lower scores in the physical and psychological QOL domains. Multivariate analyses showed that better social support independently predicted higher QOL in all domains, whereas more severe positive symptoms predicted worse psychological and environmental domains. Overall psychopathology predicted both worse physical and psychological domains; depressive symptoms and being married predicted worse physical and social QOL, respectively. Our results suggest that therapeutic and psychosocial interventions alleviating positive and depressive symptoms and improving poor social support and marriage-related problems in Chinese patients with schizophrenia might be of considerable benefit in improving their QOL.
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Kim S, Solari H, Weiden PJ, Bishop JR. Paliperidone palmitate injection for the acute and maintenance treatment of schizophrenia in adults. Patient Prefer Adherence 2012; 6:533-45. [PMID: 22879739 PMCID: PMC3413070 DOI: 10.2147/ppa.s20657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To review the use of paliperidone palmitate in treatment of patients with schizophrenia. METHODS Published clinical trial data for the development and utilization of paliperidone palmitate for the treatment of schizophrenia were assessed in this review. Four short-term, randomized, double-blind, placebo-controlled trials investigated the efficacy of paliperidone palmitate in acute exacerbation of schizophrenia. Paliperidone palmitate was also studied as a maintenance treatment to prevent or delay relapse in stable schizophrenia. In addition, paliperidone palmitate was compared to risperidone long-acting injection for noninferiority in three studies. RESULTS Paliperidone palmitate has been shown to be effective in reducing symptoms as measured by the Positive and Negative Syndrome Scale total scores in the four acute treatment studies. In the maintenance treatment studies, paliperidone palmitate was found to be more effective than placebo in preventing or delaying the time to first relapse in stable schizophrenia patients. In addition, paliperidone palmitate was shown to be noninferior to risperidone long-acting injection in two studies. It was shown to be reasonably well tolerated in all clinical trials. Acute treatment phase should be initiated with a dose of 234 mg on day one and 156 mg on day eight, followed by a recommended monthly maintenance dose of 39-234 mg based on efficacy and tolerability results from the clinical studies. CONCLUSION Providing an optimal long-term treatment can be challenging. Paliperidone palmitate can be used as an acute treatment even in outpatient setting, and it has shown to be well tolerated by patients. Also, it does not require overlapping oral antipsychotic supplementation while being initiated, and is dosed once per month.
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Affiliation(s)
- Shiyun Kim
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Hugo Solari
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Peter J Weiden
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Jeffrey R Bishop
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
- Correspondence: Jeffrey R Bishop, University of Illinois at Chicago College of Pharmacy, Department of Pharmacy, Practice, 833 S Wood St Rm 164, (M/C886), Chicago, IL 60612, USA, Tel +1 312 413 3495, Fax +1 312 996 0379, Email
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Caroli F, Raymondet P, Izard I, Plas J, Gall B, Delgado A. Opinions of French patients with schizophrenia regarding injectable medication. Patient Prefer Adherence 2011; 5:165-71. [PMID: 21573047 PMCID: PMC3090377 DOI: 10.2147/ppa.s15337] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Use of patient-reported outcomes to assess the care of individuals with schizophrenia is increasing. We describe a survey (questionnaire) that evaluates patient opinions on long-acting injectable antipsychotic medication. METHODS Psychiatrists throughout France selected consenting patients with schizophrenia who had received at least three months' treatment with a long-acting injectable antipsychotic (either typical or atypical) as outpatients to be interviewed by professional interviewers. RESULTS A total of 206 patients were interviewed at 19 sites. Ninety-five percent of the patients had been treated with more than one form of dosage; for these individuals, injections were the favored dosage form, being preferred by 47% (compared with 35%, 7%, and 1% expressing a preference for oral tablets, drinkable solutions, and orally disintegrating tablets, respectively, whilst 10% of patients did not express a preference). Over two-thirds of the interviewees (67%) said they felt better having received an injectable treatment than they felt before, and over half the patients (51%) considered injectable therapy to be more effective than other medication. In addition, the majority of the sample (70%) felt better supported in their illness by virtue of regular contact with the doctor or nurse who administered their injection. Patients also reported that injectable treatment could impact positively on their plans and aspirations, with the most frequent consideration for the future relating to finding a job (49% of the sample). CONCLUSION In this survey, patients with schizophrenia had favorable opinions on injectable medication. Ultimately, positive experiences associated with the treatment of schizophrenia in patients receiving long-acting injectable medication may influence the prescription of such therapy by health care providers.
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Affiliation(s)
- François Caroli
- Psychiatry Department, Centre Hospitalier Sainte-Anne, Paris, France
- Correspondence: François Caroli, Psychiatry Department, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75674 Paris Cedex, France, Tel +33 145 658 309, Fax +33 145 658 740, Email
| | | | | | - Joel Plas
- Psychiatry Department, CH Jean Charcot, Vélizy, France
| | - Bérengère Gall
- Opinion and Health Department, BVA Group, Boulogne-Billancourt, France
| | - Antonio Delgado
- Neurosciences Department, Janssen Cilag France, Issy-les-Moulineaux, France
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Kao YC, Liu YP, Chou MK, Cheng TH. Subjective quality of life in patients with chronic schizophrenia: relationships between psychosocial and clinical characteristics. Compr Psychiatry 2011; 52:171-80. [PMID: 21295224 DOI: 10.1016/j.comppsych.2010.05.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 04/17/2010] [Accepted: 05/25/2010] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Using the theoretical framework of quality of life (QOL), many studies have demonstrated that the beliefs individuals hold about their QOL are important in predicting health outcomes. This study tested the Taiwanese version of the World Health Organization Quality of Life-Brief (WHOQOL-BREF) assessment in schizophrenia patients. The WHOQOL-BREF is a cross-cultural and widely used measure for assessing health-related QOL. This brief version of the questionnaire derived from the concepts included in the 100-item WHOQOL questionnaire was adapted for use in Taiwan. METHODS In the current cross-sectional study, 104 patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for schizophrenia or schizoaffective disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were recruited and independently interviewed using the Taiwanese version of the WHOQOL-BREF. Patients were also examined using various other scales assessing insight, symptom severity, general psychopathology, and antipsychotic-induced side effects. In addition, we analyzed demographic data, clinical variables, and several self-rating scales as correlates of the Taiwanese version of the WHOQOL-BREF. RESULTS As predicted, age, onset of illness, insight measures, symptom severity, general psychopathology, and antipsychotic-induced side effects were all significantly related to the QOL scores. Multiple regression analyses revealed that depressive symptoms, antipsychotic-induced parkinsonism side effects, hopelessness, and age at illness onset were the 4 strongest predictors of subjective QOL in schizophrenia patients. These variables accounted for 39.2% of the total variance of this QOL model. CONCLUSIONS The results suggest that the WHOQOL-BREF is a promising model for mental assessing health problems in schizophrenia patients. Furthermore, the present findings highlight the importance of understanding the complex nature of the concept of QOL. Our study also supports the belief that different domains of QOL are likely to have different predictors.
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Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, SongShan Armed Forces General Hospital, Taipei 10581, Taiwan, Republic of China.
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Kao YC, Liu YP. Effects of age of onset on clinical characteristics in schizophrenia spectrum disorders. BMC Psychiatry 2010; 10:63. [PMID: 20718964 PMCID: PMC2933645 DOI: 10.1186/1471-244x-10-63] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 08/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last few decades, research regarding the age of onset of schizophrenia and its relationship with other clinical variables has been incorporated into clinical practices. However, reports of potential differences in demographic and clinical characteristics between early- and adult-onset schizophrenia spectrum disorders have been controversial. Thus, this study aims to assess differences in demographic and clinical characteristics correlated with age of illness onset in schizophrenia spectrum disorders. METHODS Data were collected from 104 patients with schizophrenia and schizoaffective disorder. Diagnosis was made via structured clinical interviews. Assessments of psychiatric symptoms and social and global functioning were completed. The effect of age of onset on demographic and clinical variables was examined using correlation analyses and binary logistic regression models. We chose 17 years of age as the cut-off for early-onset schizophrenia spectrum disorders based on a recent clinical consensus. We further investigated differences in the severity of psychopathology and other clinical variables between the early- and adult-onset groups. RESULTS The binary logistic regression analysis showed that age of onset was significantly related to the cognitive component of the Positive and Negative Syndrome Scale (PANSS) (odds ratio, OR = 0.58; 95% confidence interval, CI = 0.872-0.985; p < 0.001) and Barratt Impulsiveness Scale (BIS) score (OR = 0.94; 95% CI = 0.447-0.744; p = 0.015). Patients with early onset of schizophrenia spectrum disorders had significantly greater levels of cognitive impairment and higher impulsivity. There were significant differences between several demographic and clinical variables, including the negative symptom component of the PANSS (p < 0.001), cognitive component of the PANSS (p < 0.001), BIS score (p = 0.05), and psychological domain of quality of life (QOL) (p = 0.05), between patients with early- and adult-onset schizophrenia spectrum disorders, having controlled for the effect of the current age and duration of illness. CONCLUSIONS Our findings support the hypothesis of an influence of age of onset on illness course in patients with schizophrenia spectrum disorders. This finding may in fact be part of a separate domain worthy of investigation for the development of interventions for early symptoms of schizophrenia.
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Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, Songshan Armed Forces General Hospital, Taipei, Taiwan
| | - Yia-Ping Liu
- Department of Physiology and Biophysics, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Taipei 114, Taiwan
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Nestoriuc Y, Orav EJ, Liang MH, Horne R, Barsky AJ. Prediction of nonspecific side effects in rheumatoid arthritis patients by beliefs about medicines. Arthritis Care Res (Hoboken) 2010; 62:791-9. [PMID: 20191574 DOI: 10.1002/acr.20160] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study examines the determinants of patients' side effects from arthritis medication. Proposed predictors were patients' beliefs about medications, objective disease activity, treatment regimen, and psychiatric and rheumatoid arthritis symptoms. METHODS In a longitudinal design, 100 rheumatoid arthritis outpatients were investigated at baseline and again at 6 months after receiving both pharmacologic and psychosocial treatment. RESULTS Multivariate analyses showed no influence of disease status, type of treatment, or psychiatric or arthritis symptoms on side effects. Heightened concerns about arthritis medication at baseline predicted side effects at baseline (partial correlation r = 0.37, P < 0.001) and at 6 months (partial correlation r = 0.25, P < 0.001) after controlling for relevant disease- and treatment-related variables. In a cross-lagged panel analysis, prior experience with side effects from arthritis medication was ruled out as a cause of heightened concerns, indicating that negative beliefs genuinely contribute to side effects. A comparison of patients who did and did not start new medications showed no difference in side effects in patients with positive beliefs about medications, but led to significantly more side effects in patients with negative beliefs. CONCLUSION Patients' beliefs about arthritis medications were stable and consistently associated with side effects. Patients with greater concerns about their arthritis medications are at higher risk for developing side effects, especially when starting new drugs. Identifying those patients is important to avoid premature drug discontinuation. Research into cause and preventability of negative attitudes to prescribed medicines is needed.
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Affiliation(s)
- Yvonne Nestoriuc
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Tsang HWH, Fong MWM, Fung KMT, Chung RCK. Perceptions on efficacy and side effects of conventional depot antipsychotics (CDA) and atypical depot antipsychotics (ADA): Psychiatrists versus patients in Hong Kong. Int J Psychiatry Clin Pract 2010; 14:23-32. [PMID: 24917229 DOI: 10.3109/13651500903282873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract Objectives. We compared the satisfaction level of psychiatrists and psychiatric patients towards conventional (CDA) and atypical (ADA) depot antipsychotics on symptom management, role functioning, and side effects. Method. Patients from an out-patient clinic of a public hospital and psychiatrists from public hospitals participated in the survey in 2007-2008. A total of 153 patients were interviewed by a tailor-made questionnaire and 72 psychiatrists self-administered a similar questionnaire. Results. Both groups shared similar attitudes towards clinical effectiveness and treatment efficacy of ADA and CDA. More patients were ambivalent towards relapse prevention of CDA than psychiatrists (30.7 vs. 16.7%, P<0.044) and three quarters of psychiatrists believed that ADA are associated with less side effects. More than half of the patients showed negative attitudes towards the effectiveness of CDA on improving quality of life (52.40%), work (57.50%), and recreation (55.50%). Psychiatrists were more aware of the limitation of CDA and severity of side effects of CDA. They did not, however, seem to incorporate patients' opinions and research findings into their clinical practice. Conclusion. Evidence-based practice and shared decision-making model between clinicians and mental patients should be advocated. More investigations should be devoted to examine the efficacy of ADA as the alternative to CDA.
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Affiliation(s)
- Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Jung HY, Hwang SSH, Yi JS, Kim Y, Kim YS. Clinician-rated functioning and patient-rated quality of life in schizophrenia: implications of their correspondence for psychopathology and side effects. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:225-30. [PMID: 19931586 DOI: 10.1016/j.pnpbp.2009.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 11/06/2009] [Accepted: 11/12/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Past studies have found inconsistent associations between subjective and objective measures of quality of life (QOL) in schizophrenia. We hypothesized that this may be due to heterogeneity in the demographic and/or clinical variables inherent in the samples and we investigated this possibility. METHODS We stratified the patients according to a descriptive measure of correspondence between self-reported QOL and clinician-rated functioning. We then examined whether heterogeneous patterns existed among the subgroups in terms of demographic variables, symptom severity, associations between self-reported and clinician-rated psychopathology and associations between side effects, QOL and functioning. RESULTS The subgroups significantly differed with respect to clinician-rated positive symptoms (F=3.075, p<.05), subjective symptoms (somatization, F=5.768, p<.01; obsessive-compulsive, F=3.885, p<.05; interpersonal sensitivity, F=8.278, p<.001; depression, F=9.368, p<.001; anxiety, F=6.909, p<.01; hostility, F=7.787, p<.01; phobic anxiety, F=9.551, p<.001; paranoia, F=5.304, p<.01; psychoticism, F=5.071, p<.01) and in- and outpatient ratio (Chi(2)=11.58, p<.01). Only the subgroup with relatively good correspondence between clinician-rated functioning and self-reported QOL showed significant low to moderate associations between the aforementioned measures and side effects. In addition, they showed similar levels of significant associations between the positive and subjective symptoms. In contrast, other discordant subgroups lacked overall associations between side effects, functioning and QOL as well as between subjective and objective measures of psychopathology. CONCLUSION Low to moderate levels of correspondence between subjective QOL and objective functioning were partly supportive of the independence of the constructs. Insight is likely to be a mediating variable of the correspondence between self-report and clinician-rated measures and should be considered in studies using self-report measures.
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Affiliation(s)
- Hee Yeon Jung
- Department of Psychiatry, Boramae Medical Center, College of Medicine Seoul National University, Seoul, 156-707, Republic of Korea
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Citrome L. Patient perspectives in the development and use of long-acting antipsychotics in schizophrenia: focus on olanzapine long-acting injection. Patient Prefer Adherence 2009; 3:345-55. [PMID: 20016798 PMCID: PMC2792872 DOI: 10.2147/ppa.s5734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Schizophrenia is a chronic mental disorder generally treated with antipsychotic medication. However, non-adherence and partial adherence to antipsychotic medication treatment is common and long-acting injectable "depot" preparations of antipsychotic medications have been used as an alternative to oral medication therapy for patients for whom adherence is a clinically significant problem, as well as for the sake of convenience and in response to patient preference. Olanzapine long-acting injection (OLAI) is a new treatment option and has been approved by several regulatory agencies for the treatment of schizophrenia. OLAI is a crystalline salt formulation of olanzapine and pamoic acid. Efficacy was established in 2 double-blind randomized clinical trials of OLAI for the treatment of acute schizophrenia and for the maintenance of response. The therapeutic OLAI dosages are 150 mg q2 weeks, 210 mg q2 weeks, 300 mg q2 weeks or q4 weeks, and 405 mg q4 weeks, administered by deep intramuscular gluteal injection with a 19-gauge needle. Injection volume ranges from 1 to 2.7 mL. OLAI has essentially the same general tolerability as that of oral olanzapine; however with the depot there is the additional risk of a post-injection delirium sedation syndrome occurring at a rate of 0.07% of injections, requiring a risk management plan that includes observing the patient for 3 hours post injection.
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Affiliation(s)
- Leslie Citrome
- Correspondence: Leslie Citrome, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA, Tel +1 845 398 5595, Fax +1 845 398 5483, Email
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Hwang SS, Lee JY, Cho SJ, Lee DW, Kim YS, Jung HY. The model of the relationships among the predictors of quality of life in chronic stage of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1113-8. [PMID: 19539682 DOI: 10.1016/j.pnpbp.2009.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 05/28/2009] [Accepted: 06/09/2009] [Indexed: 11/15/2022]
Abstract
We attempted to formulate a model of quality of life (QoL) in chronic stage of schizophrenia with 72 patients by including key variables, i.e., psychopathology, insight, executive functioning, and side effects, proposed to be its significant predictors in previous studies. We applied the structural equation modelling (SEM) method to simultaneously test a number of possible hypotheses concerning the inter-relations among the predictors of QoL in schizophrenia patients by formulating possible models and examining their levels of fitness. Our most fit model (X(2)=2.106, df=4, P=0.716; CFI=1.000; TLI=1.213; RMSEA=0.000, LO=0.000, HI=0.132) showed that the severity of psychopathology not only directly causes poor QoL, but also by adversely affecting insight. On the other hand, executive function may not be affected significantly by psychopathology, but executive function still plays an important role in determining the QoL not only directly, but also indirectly by influencing self-evaluation of side-effects. Impaired insight and executive function caused by severe level of psychopathology contribute to an increased reporting of side-effects, resulting in cumulative dysfunction in daily life for patients with chronic schizophrenia. Our study illustrates that the complexity of the relationships among the predictors of QoL in chronic patients of schizophrenia should be considered when designing studies on QoL of this group.
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Affiliation(s)
- Samuel S Hwang
- Interdisciplinary Study in Brain Science, Seoul National University College of Natural Science, Seoul 110-744, Republic of Korea.
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Association of Adverse Drug Effects With Subjective Well-Being in Patients With Schizophrenia Receiving Stable Doses of Risperidone. Clin Neuropharmacol 2009; 32:250-3. [DOI: 10.1097/wnf.0b013e3181a5d08c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bebbington PE, Angermeyer M, Azorin JM, Marwaha S, Marteau F, Toumi M. Side-effects of antipsychotic medication and health-related quality of life in schizophrenia. Acta Psychiatr Scand 2009:22-8. [PMID: 19132963 DOI: 10.1111/j.1600-0447.2008.01310.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This analysis used data from the large (n = 1208) European Schizophrenia Cohort to examine the association between subjective side-effects of antipsychotic medication and the Mental and Physical Composite Scores (MCS; PCS) of the SF-36 scale. METHOD Relationships between the subjective evaluation of side-effects identified from the Subjective Side-Effects Scale and the adjusted mean score on the PCS and MCS were examined. Where appropriate, these associations of subjective side-effects were compared with those of the same side-effects measured objectively. RESULTS In this study, subjective side-effects of antipsychotic medication were linked either to both the PCS and the MCS or, in a few instances, to neither. Subjective evaluations of sexual side-effects were associated only with the MCS, those of sialorrhoea only with the PCS. Objective ratings of extrapyramidal side-effects were related neither to PCS nor to MCS. CONCLUSION These data suggest that side-effects, whether subjective or objective, may need to be considered individually in relation to their impact on quality of life.
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Rocca P, Crivelli B, Marino F, Mongini T, Portaleone F, Bogetto F. Correlations of attitudes toward antipsychotic drugs with insight and objective psychopathology in schizophrenia. Compr Psychiatry 2008; 49:170-6. [PMID: 18243890 DOI: 10.1016/j.comppsych.2007.08.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 08/23/2007] [Accepted: 08/29/2007] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of this cross-sectional study was to examine the relationships between attitudes toward antipsychotics, insight, and other clinical variables in stable schizophrenia. METHODS Fifty Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision-(DSM-IV-TR)-diagnosed schizophrenic outpatients were evaluated through a psychiatric assessment. Drug attitudes were measured using the Drug Attitude Inventory and insight using the Scale for the Assessment of Unawareness of Mental Disorder. Differences between patients taking first- or second-generation antipsychotics were investigated. RESULTS Lack of insight, more severe scores on the positive and general psychopathology subscales of the Positive and Negative Syndrome Scale (PANSS), and later age at onset of schizophrenia correlated with worse global medication attitude. The multiple regression analysis revealed that unawareness of the need of treatment predicted poorer drug global attitude (R(2) = 0.312). Patients taking second-generation antipsychotics showed lower negative attitudes and better global drug attitudes than patients treated with neuroleptics. CONCLUSION The impact of the awareness of the need for treatment on global medication attitude needs to be a main focus of interventions targeting compliance.
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Affiliation(s)
- Paola Rocca
- Department of Neuroscience, Psychiatric Section, University of Turin, Via Cherasco 11, 10126 Turin, Italy.
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Foster PhD JM, van der Molen MD, PhD T, Caeser PhD M, Hannaford MD, PhD P. The use of questionnaires for measuring patient-reported side effects of drugs: its importance and methodological challenges. Pharmacoepidemiol Drug Saf 2008; 17:278-96. [DOI: 10.1002/pds.1533] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Subjective quality of life in outpatients with schizophrenia in Hong Kong and Beijing: relationship to socio-demographic and clinical factors. Qual Life Res 2007; 17:27-36. [DOI: 10.1007/s11136-007-9285-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 11/12/2007] [Indexed: 11/26/2022]
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Hofer A, Rettenbacher MA, Edlinger M, Kemmler G, Widschwendter CG, Fleischhacker WW. Subjective response and attitudes toward antipsychotic drug therapy during the initial treatment period: a prospective follow-up study in patients with schizophrenia. Acta Psychiatr Scand 2007; 116:354-61. [PMID: 17868428 DOI: 10.1111/j.1600-0447.2007.01087.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this prospective study, patients with schizophrenia were followed up for 3 months to investigate the impact of sociodemographic factors, psychopathology, change in psychopathology and side effects on subjective response and attitudes toward antipsychotics during the initial treatment period. METHOD We investigated 42 patients starting treatment with a new-generation antipsychotic. Next to the registration of demographic data various rating scales were used: the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and the Drug Attitude Inventory (DAI). RESULTS Two patients experienced a first episode of the illness and were neuroleptic naïve, and 40 had suffered from at least one prior episode of schizophrenia. Longer duration of illness as well as the amelioration of psychopathological symptoms had a positive impact on subjective response to treatment. Correlations between antipsychotic-induced side effects and drug attitude tended to be weak. CONCLUSION Our results emphasize the necessity of improving psychopathological symptoms during the initial treatment period to improve attitudes toward and compliance with treatment.
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Affiliation(s)
- A Hofer
- Department of Biological Psychiatry, Medical University Innsbruck, Innsbruck, Austria.
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Bobes J, Garcia-Portilla MP, Bascaran MT, Saiz PA, Bousoño M. Quality of life in schizophrenic patients. DIALOGUES IN CLINICAL NEUROSCIENCE 2007. [PMID: 17726919 PMCID: PMC3181847 DOI: 10.31887/dcns.2007.9.2/jbobes] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
In the last decades, there has been increased interest in the field of quality of life in mental disorders in general, and particularly in schizophrenia. In addition, the appearance of the atypical antipsychotic drugs (amisul pride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone) with different therapeutic and side-effect profiles, has promoted a greater interest in assessing the quality of life of schizophrenic patients. In this paper we will briefly summarize the difficulties in assessing quality of life in schizophrenic patients, as well as the results concerning their quality of life and the influence of psychopathology, especially negative and depressive symptoms, on it. We will also review data from recent clinical trials showing the impact of antipsychotic treatments and their side effects upon quality of life.
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Affiliation(s)
- Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain.
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Neuroticism, Side Effects, and Health Perceptions Among HIV-Infected Individuals on Antiretroviral Medications. J Clin Psychol Med Settings 2007; 14:69-77. [PMID: 18568088 DOI: 10.1007/s10880-007-9056-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Side effects from antiretroviral therapy (ART) for HIV disease can deter treatment, impact quality of life, and impede medication adherence. Individual differences in neuroticism may account for variations in the experience of side effects and perceptions of health status. Cross-sectional assessments were conducted with 258 HIV-infected participants with confirmed HIV infection and current ART regimen. Structural equation modeling (SEM) was used to evaluate a model of self-reported ART side effect frequency and severity and perceived health status, as related to symptoms of neuroticism. Symptoms of neuroticism were associated with greater reports of ART side effects and poorer perceived health but unrelated to reported CD4 count and viral load. A structural model was supported in which greater symptoms of neuroticism are linked to poorer perceived health through greater side effect frequency and severity. Individual differences in symptoms of neuroticism can explain variations in side effect reporting and consequential impairments in perceived health in the context of HIV treatment. Identification and intervention with individuals high in symptoms of neuroticism may be warranted to alleviate side effect-related concerns and maximize treatment benefit.
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Putzhammer A, Klein HE. Quantitative analysis of motor disturbances in schizophrenic patients. DIALOGUES IN CLINICAL NEUROSCIENCE 2006. [PMID: 16640123 PMCID: PMC3181753 DOI: 10.31887/dcns.2006.8.1/aputzhammer] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of neurological signs and disturbed psychomotor performance have been consistently confirmed by clinical studies in schizophrenic patients. These parameters are mainly assessed by using clinical rating scales. In recent years, new approaches such as ultrasonic movement analysis systems have been introduced in order to objectively evaluate motor disturbances in schizophrenic patients. Ultrasonic movement analysis systems calculate the three-dimensional positions of tiny markers, which are attached to moving body parts, with high spatial and temporal resolution. Thus, key parameters of gait and hand movements can be determined precisely. This article summarizes and discusses several studies using these new methods. Results indicate that schizophrenia causes a specific motor deficit pattern, with a predominant disturbance of spatial parameters. Conventional antipsychotic treatment usually worsens these deficits, whereas the effects of atypical antipsychotic treatments are less pronounced. Disturbed motor performance can be normalized by external sensory stimuli, but only when no major attentional processes are required, and it can be enhanced by an attentional strategy, but not to the extent that motor parameters are normalized.
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Affiliation(s)
- Albert Putzhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, D-93042 Regensburg, Germany.
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Bozikas VP, Kosmidis MH, Kafantari A, Gamvrula K, Vasiliadou E, Petrikis P, Fokas K, Karavatos A. Community dysfunction in schizophrenia: rate-limiting factors. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:463-70. [PMID: 16442195 DOI: 10.1016/j.pnpbp.2005.11.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2005] [Indexed: 10/25/2022]
Abstract
The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.
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Affiliation(s)
- Vasilis P Bozikas
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Greece.
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de Souza LA, Coutinho ESF. The quality of life of people with schizophrenia living in community in Rio de Janeiro, Brazil. Soc Psychiatry Psychiatr Epidemiol 2006; 41:347-56. [PMID: 16520882 DOI: 10.1007/s00127-006-0042-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2006] [Indexed: 11/25/2022]
Abstract
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.
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Souza LAD, Coutinho ESF. Fatores associados à qualidade de vida de pacientes com esquizofrenia. BRAZILIAN JOURNAL OF PSYCHIATRY 2006; 28:50-8. [PMID: 16612491 DOI: 10.1590/s1516-44462006000100011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Leonardo Araújo de Souza
- Departamento de Epidemiologia, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
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Abstract
OBJECTIVE To investigate influencing factors for lay perception of mental illness severity and their effects on the stigma of mental illness. METHOD Selective review including attitude surveys assessing social distance towards different diagnostic labels, and attitudes towards treatment professions, treatment strategies, and psychopharmacotherapy. RESULTS Lays differentiate in their attitudes towards people with mental illness according to the given diagnostic label, the involved treatment professions or institutions, the applied treatment methods, and the perceived psychosocial disability. CONCLUSION Beside perceived treatment intensity and diagnostic label, the perception of social disability of mentally ill people accounts for a differentiated stigma. The question arises how anti-stigma-programmes can include the topic of social disability into their messages without risking to strengthen the stigma of mental illness.
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Affiliation(s)
- W Gaebel
- Department of Psychiatry Düsseldorf, Düsseldorf, Germany
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TOMOTAKE MASAHITO. SUBJECTIVE AND OBJECTIVE MEASURES OF QUALITY OF LIFE HAVE DIFFERENT PREDICTORS FOR PEOPLE WITH SCHIZOPHRENIA. Psychol Rep 2006. [DOI: 10.2466/pr0.99.6.477-487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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