Current issues in schizophrenia: overview of patient acceptability, functioning capacity and quality of life.
ABSTRACT The increasing interest in the subjective wellbeing and quality of life (QoL) of patients with schizophrenia represents a conceptual extension of therapeutic outcome criteria. For a long time, the reduction of positive symptoms alone was the most important outcome parameter, but the development of atypical antipsychotic drugs in the early 1990s resulted in the adoption of more wide-reaching measures of therapeutic outcome. Patient satisfaction appears to be strongly related to their willingness to be or stay engaged in psychosocial and pharmacological treatment, and therefore to the symptomatic and functional outcome. Existing studies that deal with QoL and subjective wellbeing differ in their methodology and are difficult to compare because of varying underlying concepts of QoL or subjective wellbeing, different assessment scales or small sample sizes. Although QoL is a heterogeneous concept, it is clearly correlated with a number of factors, including illness, medication and stress process-related variables. Various protective factors have been identified; among these are personality traits, the degree of social support and treatment interventions. In clinical studies, atypical antipsychotic agents are associated with greater improvements in QoL and subjective wellbeing than are conventional agents. The reason for this is probably the ability of atypical agents to have a positive impact on factors most associated with QoL, such as negative and affective symptoms and drug tolerability. The most appropriate clinical approach to maximize QoL and subjective wellbeing for patients with schizophrenia is to use atypical antipsychotic drugs as a first-line treatment approach. Ideally, an atypical drug which is known not to have a negative effect on attention, affect or motivation should be chosen.
- [Show abstract] [Hide abstract]
ABSTRACT: Objective The purpose of this study was to examine the relative contributions of disorganization and cognitive dysfunction to quality of life (QOL) in patients with stable schizophrenia. Methods A total of 276 consecutive outpatients with stable schizophrenia were enrolled in a cross-sectional study. We performed a mediation analysis to assess the specific effect of disorganization on QOL, as assessed by the Heinrichs–Carpenter Quality of Life Scale (QLS), and the possible mediating role of cognitive dysfunction. Results Our findings were as follows: (i) disorganization was negatively related to the total QLS score; (ii) disorganization was negatively related to two of the four QLS domains, namely the role-functioning domain (occupational/educational) and the intrapsychic functioning domain (e.g., motivation, curiosity, and empathy); and (iii) verbal memory was a partial mediator of the relationship between disorganization and QLS (the total score and the two above-mentioned domains). Conclusions Disorganization demonstrated direct and indirect effects via verbal memory on two domains of functioning, as measured by the QLS. These results highlight the importance of improving disorganization and cognition (particularly verbal memory) to improve the functional outcomes of patients with schizophrenia.Schizophrenia Research 01/2014; · 4.59 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Assessing quality of life (QoL) as a patient-reported outcome in adult psychiatry poses challenges in terms of concepts, methods, and applications in research and practice. This review will outline conceptually the construct of QoL, its dimensionality, and its representation across patient groups. Methodological challenges are examined, along with principles of QoL instrument development and testing, as well as across cultures. Application of instruments in epidemiological, clinical health economics, and health services research is reviewed based on pertinent literature. Validated measures for depression, psychosis, and anxiety disorders are available in adult psychiatry, and are increasingly used in research. Still, targeted measures are lacking for many mental health conditions and only rarely are tools applied in the practice context. Progress has been made in the development of instruments that are now ready for implementation. The information to be gained is valuable for identifying patient-reported needs for and benefits of treatment.Dialogues in clinical neuroscience 06/2014; 16(2):137-45.
Article: Management of Schizophrenia[Show abstract] [Hide abstract]
ABSTRACT: Schizophrenia is a chronic disease that typically manifests during adolescence and early adulthood. Treatment of this disease consumes a significant proportion of the healthcare budget (billions of dollars in the US). Primary management options for schizophrenia include both pharmacologic and psychosocial interventions, with antipsychotic therapy (typicals or atypicals) being the mainstay of any treatment plan. Atypical agents are recommended in current guidelines as first-line treatments for patients with newly diagnosed schizophrenia. The newer atypical antipsychotic agents have a lower propensity to cause extrapyramidal symptoms and tardive dyskinesia, and are at least as effective as typical agents. Long-acting injectable formulations of antipsychotic drugs help to ensure drug delivery and are recommended in patients who are partially or fully noncompliant, or who prefer this formulation. The goal of using these agents is to reduce noncompliance, thus reducing the likelihood of relapse and/or hospitalization, and ultimately reducing treatment costs. Benefits associated with long-acting formulations include the maintenance of stable plasma concentrations, the reduction of overdose risks, and the establishment of regular contact between the patient and their healthcare provider. Currently, risperidone is the only atypical agent available as a long-acting injectable formulation. In patients with schizophrenia, long-acting injectable risperidone (25–50mg every 2 weeks) is no less effective than once-daily oral risperidone, has superior efficacy to placebo over the short term, and significantly improves symptoms over the long term in patients who are symptomatically stable at baseline. Long-acting injectable risperidone is well tolerated and has a tolerability profile similar to that of oral risperidone, apart from injection-site reactions, which are generally mild and transient. This formulation of risperidone reduces the incidence of hospitalization and significantly improves health-related quality of life (HR-QOL; in particular mental health-related domains) in patients with symptomatically stable schizophrenia. Pharmacoeconomic models have indicated that long-acting injectable risperidone — relative to oral risperidone, oral olanzapine, or long-acting haloperidol — is associated with cost savings and is the dominant strategy in terms of cost effectiveness. The efficacy and tolerability profile of long-acting injectable risperidone, its ability to reduce hospitalization rates and improve HR-QOL, and its demonstrated cost effectiveness in pharmacoeconomic models support the use of this agent in the management of schizophrenia.Disease Management and Health Outcomes 14(2). · 0.36 Impact Factor