Article

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

Centre for Psychosocial Medicine, Department for Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany.
CNS Drugs (Impact Factor: 4.38). 02/2004; 18 Suppl 2:5-17; discussion 41-3.
Source: PubMed

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.

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    • "However, SWN scores are not just reducible to BDI scores; a substantial proportion (46%) of the variance in SWN scores remained unexplained by BDI scores, supporting the utility of conducting independent analyses. Indeed, SW is the central predictor of medication compliance (Karow et al. 2007) and constitutes a distinct outcome measure in schizophrenia (Lambert & Naber, 2004); hence, investigating SW as a specific target of research is warranted . Examination of the items on these scales also reveals that they are founded on different constructs. "
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    Psychological Medicine 07/2014; 45(03):1-12. DOI:10.1017/S0033291714001718 · 5.43 Impact Factor
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    • "It is important to note that while patients in acute psychoses might not be able to respond to health-related QoL questionnaires, this is not the case for patients in remission. Reliable and consistent reporting has been demonstrated in many studies of patients suffering from mental health problems.61,62 "
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    Dialogues in clinical neuroscience 06/2014; 16(2):137-45.
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    • "These are amongst several challenges facing psychiatrists when assessing functioning in their daily clinical practice. Others include difficulty in distinguishing functioning deficits from the effects of negative symptoms [7,45] and a frequent lack of distinction between quality of life and functioning measures [7,46]. In addition, only a relatively small number of randomized, controlled clinical trials of antipsychotic agents have assessed social functioning using a specific scale [7]. "
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    ABSTRACT: It has been estimated that as many as two thirds of patients with schizophrenia are unable to perform basic personal and social roles or activities. Occupational functioning and social functioning, as well as independent living, are considered as core domains of patient functioning. Improvement in patient functioning has also been recognized as an important treatment goal in guidelines and an important outcome by regulatory agencies. Nevertheless, information is lacking on how these aspects are being considered by psychiatrists across the world and how they are being assessed and managed. The ‘Europe, the Middle East and Africa functioning survey’ was designed to canvas opinions of psychiatrists across these regions to ascertain their perceptions of the clinical importance, assessment and management of functioning amongst their patients with schizophrenia. The survey comprised 17 questions and was conducted from March to April 2011 in 42 countries. Data collected included the demographics of respondents and their opinions regarding personal and social functioning in patients with schizophrenia. Results were obtained from 4,163 clinicians. Psychiatrists estimated that more than two thirds (70%) of their patients with schizophrenia showed impaired or very poor levels of functioning. The majority of psychiatrists (92%) believed that personal and social functioning was an important treatment goal for patients with schizophrenia, and 91% believed it was an important goal for patients’ families. The majority of psychiatrists (55%) assess the personal and social functioning of their patient at each visit; however, 81% reported that they determine the level of functioning through clinical interview and not by using a specific assessment scale. To manage personal and social functioning in their patients, 26% of psychiatrists prefer pharmacological interventions, whereas 46% prefer psychosocial interventions. Psychiatrists recognize that functioning is impaired/very poor in patients with schizophrenia, and there is still an important need to address functioning as a main treatment goal for patients with schizophrenia.
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