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.
- SourceAvailable from: Tetsuya Tanioka[Show abstract] [Hide abstract]
ABSTRACT: Aim. The purpose of this retrospective study was to evaluate changes in clinical indicators which influence the quality of life (QOL) of patients with schizophrenia treated by antipsychotic therapy before and after switching to aripiprazole. Methods. A retrospective chart review of 27 patients diagnosed with schizophrenia and who were switched from one antipsychotic to aripiprazole was performed. Clinical indicators about the daily dosage of antipsychotics and antiparkinsonian drugs, psychiatric condition, and glucose/lipid metabolism, clinical evaluation by nursing observation were used to measure the responsiveness of subjects to aripiprazole. Results. Of the 27 subjects, 14 responded to the switch to aripiprazole with significant improvement of the Brief Psychiatric Rating Scale (BPRS) score (P = 0.04), significant decrease in dosage of antipsychotics in 71% of patients (P = 0.03), and tendency toward reduction in dosage of antiparkinsonian drugs (P = 0.07) and body mass index (BMI) (P = 0.06). However, 8 of 27 subjects had a significant increase in lipid levels after switching to aripiprazole (P = 0.01). Conclusion. QOL for subjects who responded to the switch to aripiprazole improved as indicated by lower doses of antipsychotic and antiparkinson medications, improvement in BPRS score, and a decrease in BMI. Results indicate little influence on patient's QOL.08/2012; 2012:454898. DOI:10.5402/2012/454898
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ABSTRACT: Objective: Over the past few decades it has been emphasized the importance of social functioning and quality of life as a part of a multidimensional assessment of outcome in the evaluation of the impact of psychosis on patients daily lives. Their relation with schizophrenia symptoms has widely been studied, showing contrasting results. Little is known concerning their relationship with subjective experiences in schizophrenia. Method: One hundred and eighteen consecutive outpatients affected by schizophrenia in stable phase of illness were recruited for the study. Clinical scales were used to assess objective (Positive and Negative Syndrome Scale: PANSS, Calgary Depression Scale for Schizophrenia: CDSS) and subjective symptoms (Questionario dei Sintomi-Base: FBF), global functioning and quality of life (Global Assessment of Functioning: GAF, Quality Of Life scale: QLS). Results: After iterative stepwise entries, the combination of three predictor variables (PANSS-positive symptoms subscale, PANSS-negative symptoms subscale, FBF) provided the best-fit GAF model for the data. The combination of two predictor variables (PANSS-negative symptoms subscale, FBF) provided the best-fit QLS-Intrapsychic Foundations subscale model for the data. Conclusions: Our study contributes to underline the necessity to include subjective experiences among the clinical features of schizophrenic patients that must be object of attention. Even if unrelated with objective symptoms assessed by PANSS, they showed a significant correlation with functional outcome and quality of life.
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ABSTRACT: Quality of life (QOL) is considered an important outcome in the treatment of schizophrenia, but the determinants of QOL are poorly understood in this population. Furthermore, previous studies have relied on combined measures of subjective QOL (usually defined as life satisfaction) and objective QOL (usually defined as participation in activities and relationships). We examined separately the clinical, functional, and cognitive predictors of subjective and objective QOL in outpatients with schizophrenia. We hypothesized that better subjective QOL would be associated with less severe negative and depressive symptoms, better objective QOL, and greater everyday functioning capacity, and that better objective QOL would be associated with less severe negative and depressive symptoms, better cognitive performance, and greater functional capacity. Participants included 88 outpatients with schizophrenia or schizoaffective disorder who completed a comprehensive series of assessments, including measures of positive, negative, and depressive symptoms; performance-based functional skills; a neuropsychological battery; and an interview measure of subjective and objective QOL. In the context of multiple predictor variables, more severe depressive symptoms and better neuropsychological functioning were independent predictors of worse subjective QOL. More severe negative symptoms predicted worse objective QOL. Functional capacity variables were not associated with subjective or objective QOL. Treatments to improve QOL in schizophrenia should focus on negative symptoms and depressive symptoms.Schizophrenia Research 02/2008; 98(1-3):201-8. DOI:10.1016/j.schres.2007.09.001 · 4.43 Impact Factor