Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis

Quality of life (QoL) has been recognized as an important outcome of schizophrenia treatment, yet the determinants of QoL for individuals with schizophrenia are not well known. Research has consistently found psychiatric symptoms to be negatively related to QoL, however, findings concerning the strength of these relationships have been mixed, making it difficult to determine the degree to which such symptoms are related to poor QoL. This research presents a systematic meta-analysis of studies examining the relationship between psychiatric symptoms and QoL in schizophrenia, in an effort to elucidate the determinants of QoL for this population. A total of 56 studies were extracted from literature searches of relevant databases for empirical reports published between 1966 and 2005 examining the relationship between positive, negative, and/or general psychiatric symptoms and QoL. Weighted effect size analyses revealed small relationships between psychiatric symptoms and QoL, with general psychopathology showing the strongest negative associations across all QoL indicators. Moderator analyses indicated that variation in effect sizes could be accounted for by differing operationalizations of QoL, study design, sample, and participant treatment setting. In particular, positive and negative symptoms were more strongly related to poor QoL among studies of schizophrenia outpatients, whereas general psychopathology showed a consistent negative relationship with QoL across all study samples and treatment settings. Implications for future research and treatment development are discussed.     

Implications of weight-based stigma and self-bias on quality of life among individuals with schizophrenia

Obesity has been associated with significant stigma and weight-related self-bias in community and clinical studies, but these issues have not been studied among individuals with schizophrenia. A consecutive series of 70 obese individuals with schizophrenia or schizoaffective disorder underwent assessment for perceptions of weight-based stigmatization, self-directed weight bias, negative affect, medication compliance, and quality of life. The levels of weight-based stigmatization and self-bias were compared with levels reported for nonpsychiatric overweight/obese samples. Weight measures were unrelated to stigma, self-bias, affect, and quality of life. Weight-based stigmatization was lower than published levels for nonpsychiatric samples, whereas levels of weight-based self-bias did not differ. After controlling for negative affect, weight-based self-bias predicted an additional 11% of the variance in the quality of life measure. Individuals with schizophrenia and schizoaffective disorder reported weight-based self-bias to the same extent as nonpsychiatric samples despite reporting less weight stigma. Weight-based self-bias was associated with poorer quality of life after controlling for negative affect.     

Relations of internalized stigma with temperament and character in patients with schizophrenia

Objective

The aim of the study was to assess the associations between self-stigma and temperament and character dimensions.

Methods

One hundred twenty outpatients with diagnosis of schizophrenia, established with Mini International Neuropsychiatric Interview were consecutively included in the study. Self-stigma was assessed with Internalized Stigma of Mental Illness (ISMI), personality dimensions with Temperament and Character Inventory, and psychopathology with Positive and Negative Symptom Scale.

Results

The results showed that higher level of harm avoidance, lower self-directedness, and persistence correlated with ISMI and all its subscales. Self-transcendence correlated with ISMI subscales alienation, discrimination, and stigma resistance. Regression analyses controlling for psychopathology, age, length of illness, and number of hospitalizations revealed that higher level of harm avoidance and low self-directedness predicted internalized stigma.

Conclusion

The finding suggests that the experience of self-stigma is related to personality dimensions. Interpretations of these findings include the possibility that, irrespective of patients' psychopathology or functional characteristics, experience of self-stigma and its consequences might depend on personality dimensions. Further studies are needed.     

Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia

Purpose

Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors.

Methods

One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale.

Results

There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains.

Conclusion

Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.     

The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia

Objective

The quality of life (QOL) of patients with schizophrenia has been found to be positively correlated with the social network and empowerment, and negatively correlated with stigma and depression. However, little is known about the way these variables impact on the QOL. The study aims to test the hypothesis that the social network, stigma and empowerment directly and indirectly by contributing to depression influence the QOL in patients with schizophrenia and schizoaffective disorders.

Method

Data were collected on demographic and clinical variables, internalized stigma, perceived devaluation and discrimination, empowerment, control convictions, depression and QOL. Structural equation modelling (SEM) was applied to examine the impact of the above-mentioned constructs on QOL.

Results

The influences of the social network, stigma, empowerment and depression on QOL were supported by the SEM. A poor social network contributed to a lack of empowerment and stigma, which resulted in depression and, in turn, in poor QOL. Interestingly, however, the social network and stigma did not show a direct effect on QOL.

Conclusion

Following a recovery approach in mental health services by focusing on the improvement of the social network, stigma reduction and especially on the development of personal strength has the potential to reduce depression in patients with psychosis and improving their QOL.     

In patients with schizophrenia,symptoms improvement can be uncorrelated with quality of life improvement

ObjectivesQuality of life has been found to be associated with symptoms in patients with schizophrenia. Nevertheless, the mechanism that underlies this association is still unclear. The objective of this paper is to prospectively evaluate the quality of life of patients with schizophrenia in relation to the concurrent evolution of their symptoms, their expectations and their perceived position in life.MethodsParticipants included 306 outpatients with schizophrenia who were interviewed at baseline, 6 and 12 months, about their quality of life (Outcome revealed by Preference in Schizophrenia, OPS) and symptoms (Positive and Negative Syndrome Scale, PANSS).ResultsQuality of life relative to subject expectations remained stable over time. A decrease in symptoms was correlated to an increase in both expectations and perceived position in life but did not correlate to quality of life.ConclusionThe level of expectations seems to play a major role in the subjective assessment of quality of life in patients with schizophrenia. Symptom improvement is not necessarily associated with quality of life improvement relative to subject expectations. Caregivers should be aware of this result so as to deal with possible disappointments in patients receiving a new efficient treatment.     

Physical activity,stigma, and quality of life in patients with epilepsy

Indication of physical activity (PA) for people with epilepsy (PWE) is debatable. This study investigated whether the International Physical Activity Questionnaire (IPAQ) score is related to the clinical aspects of epilepsy, QOLIE-31, and the Stigma Scale of Epilepsy (SSE) score of 67 PWE at a significance level of 5% (p < 0.05).About one-third (32.8%) of the PWE were sedentary/irregularly active. Lower QOLIE-31 scores and higher SSE scores were found in PWE who did not practice PA for fear of seizures and in sedentary/irregularly active PWE. Twenty-three percent of the PWE stopped practicing PA for fear of seizures. The predictive factors in the logistic regression equation for not practicing physical activity for fear of seizures were the presence of depressive disorder (p = 0.049) and temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) (p = 0.024).Most PWE are sedentary and do not practice PA for fear of seizures. Physical activity is negatively influenced by clinical aspects of epilepsy. Less PA is associated with depressive disorder, worse quality of life, and higher perception of stigma.     

Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms, insight and quality of life

OBJECTIVE: Impairments in laboratory tasks of metacognition appear to be associated with symptoms, functioning, and neurocognition in schizophrenia. We sought to replicate these results in a study of metacognition within personal narratives of self and illness. METHOD: Narratives of 61 men with schizophrenia were rated using the Metacognition Assessment Scale and correlated with concurrent assessment of symptoms, quality of life, neurocognition and insight. RESULTS: Controlling for age and education, understanding of one's own mind was linked with better neurocognition across multiple domains, and lesser emotional withdrawal. Greater understanding of other's mind was linked with better verbal memory and less emotional withdrawal. Greater metacognition in the context of purposeful problem solving was associated with better verbal memory, insight and social function, and less emotional withdrawal and paranoia. CONCLUSION: Deficits in metacognition within the narratives of persons with schizophrenia are linked with symptoms, quality of life, neurocognition and poorer awareness of illness.     

Anxiety symptoms and quality of life in middle-aged and older outpatients with schizophrenia and schizoaffective disorder

OBJECTIVE: This study examined whether anxiety symptoms make an independent contribution to poorer quality of life among middle-aged and older outpatients with schizophrenia or schizoaffective disorder. METHOD: We evaluated data from an ongoing study of 163 older patients with DSM-III-R or DSM-IV schizophrenia or schizoaffective disorder who were enrolled in research at the University of California, San Diego, Advanced Center for Interventions and Services Research from October 1992 to April 1998. Measures used were the anxiety, somatization, obsessive-compulsive, and phobic anxiety subscales of the Brief Symptom Inventory. We performed hierarchical multiple regressions with forced entry of variables to determine whether anxiety symptoms significantly predicted poorer health-related quality of life (measured by 2 scales) after controlling for demographic variables, akathisia, cognitive impairment, depressive symptoms, and overall psychopathology. RESULTS: Anxiety symptoms were associated with poorer outcomes on overall quality of well-being and subscales representing vitality, social functioning, and role functioning limitations due to physical problems. In most cases, the proportion of variance in quality of life accounted for by anxiety symptoms was greater than that accounted for by depressive symptoms. CONCLUSIONS: Results suggest that anxiety symptoms have a significant negative impact on the quality of life of middle-aged and older patients with schizophrenia and schizoaffective disorder.     

The power to resist: The relationship between power,stigma, and negative symptoms in schizophrenia

Stigmatizing beliefs about mental illness can be a daily struggle for people with schizophrenia. While investigations into the impact of internalizing stigma on negative symptoms have yielded mixed results, resistance to stigmatizing beliefs has received little attention. In this study, we examined the linkage between internalized stigma, stigma resistance, negative symptoms, and social power, or perceived ability to influence others during social interactions among people with schizophrenia. Further, we sought to determine whether resistance to stigma would be bolstered by social power, with greater power in relationships with other possibly buffering against motivation/pleasure negative symptoms. Fifty-one people with schizophrenia or schizoaffective disorder completed measures of social power, internalized stigma, and stigma resistance. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS). Greater social power was associated with less internalized stigma and negative symptoms as well as more stigma resistance. Further, the relationship between social power and negative symptoms was partially mediated by stigma resistance. These findings provide evidence for the role of stigma resistance as a viable target for psychosocial interventions aimed at improving motivation and social power in people with schizophrenia.     

Brief reports: crisis intervention team training: changes in knowledge, attitudes, and stigma related to schizophrenia

OBJECTIVE: Crisis intervention team (CIT) training provides police officers with knowledge and skills to improve their responses to individuals with mental illnesses. This study determined changes in knowledge, attitudes, and social distance related to schizophrenia among police officers after CIT training. METHODS: A survey was administered to 159 officers immediately before and after a 40-hour CIT training program in Georgia. Pre- and posttest data were gathered from surveys taken between December 2004 and July 2005. RESULTS: After the training, officers reported improved attitudes regarding aggressiveness among individuals with schizophrenia, became more supportive of treatment programs for schizophrenia, evidenced greater knowledge about schizophrenia, and reported less social distance toward individuals with schizophrenia. CONCLUSIONS: This study supports the hypothesis that an educational program for law enforcement officers may reduce stigmatizing attitudes toward persons with schizophrenia.     

Negative symptoms and concordant impairments in attention in schizophrenia: Associations with social functioning, hope, self-esteem and internalized stigma

Research has suggested that negative symptoms in schizophrenia may be closely linked to impairments in schizophrenia. Research on the strength and nature of this association has been equivocal, however. One possible explanation is that there are two distinct groups of persons with negative symptoms: those with and those without attentional impairments. To examine this question we performed a cluster analysis on 99 adults with schizophrenia or schizoaffective disorder on the basis of their level of negative symptoms and performance on a continuous performance task. Four groups were found: low negative/relatively better attention (n = 31), low negative/relatively poor attention (n = 20), high negative/ relatively poor attention (n = 28), and high negative/relatively better attention (n = 20). To determine whether these groups differed meaningfully from one another, we next compared their performance on other assessments of positive symptoms, social function, self-esteem and stigma. A MANOVA found significant differences (Wilks' lambda F = 3.2; p < .01) with the high negative/poor attention group having poorer self esteem and greater acceptance of stigma than the other three groups and the high negative/relatively better attention group having higher levels of positive symptoms than the other groups. Implications for research and treatment are discussed.     

阿立哌唑治疗精神分裂症后抑郁的临床疗效及患者生活质量分析

目的 分析比较阿立哌唑与利培酮治疗精神分裂症后抑郁的临床疗效和患者生活质量改善状况. 方法 选择北京市大兴区精神病医院自2011年1月至2012年6月收冶的符合精神分裂症后抑郁诊断标准、汉密尔顿抑郁量表(HAMD) 17项评分≥18分的88例患者,按随机数字表法分为阿立哌唑组和利培酮组(每组各44例),分别给予阿立哌唑10～30 mg/d或利培酮2～6 mg/d治疗,疗程共24周.于治疗前及治疗第4、12、24周末对患者采用阳性与阴性症状量表(PANSS)评定精神症状的变化,采用HAMD量表评定抑郁症状的变化,采用临床大体印象量表疾病严重程度评分(CGI-SI)评定总体疗效;于治疗前及第24周末对患者采用世界卫生组织编制的生活质量量表(QOL-100)评定生活质量变化. 结果 治疗前,阿立哌唑组与利培酮组患者PANSS量表总分、阳性症状评分、阴性症状评分、一般精神病理评分及HAMD量表总分、CGI-SI量表总分、QOL-100量表总分比较差异均无统计学意义(P＞0.05).治疗后,阿立哌唑组第4周末阳性症状评分、第12、24周末阴性症状评分、第24周末一般精神病理评分及第4、12、24周末HAMD量表总分、第4周末CGI-SI量表总分、第24周末QOL-100量表总分较利培酮组明显好,差异有统计学意义(P＜0.05).治疗前后,除阿立哌唑组治疗第4周末阴性症状评分、利培酮组治疗第4周末HAMD量表总分外,其余各量表总分及分项评分与治疗前比较差异均有统计学意义(P＜0.05). 结论 阿立哌唑能有效减轻精神分裂症后抑郁患者的阴性症状和抑郁症状,提高患者生活质量.     

Interpersonal factors contributing to the stigma of schizophrenia: social skills, perceived attractiveness, and symptoms

This study investigated the interpersonal factors (i.e., social skills, symptoms, perceived physical attractiveness) which are related to the stigma of schizophrenia. Social skills performance was assessed for 39 individuals with schizophrenia who participated in two role-plays with a confederate. Social skills ratings comprised 'overall social skill', 'meshing', 'clarity', and 'fluency' of speech, 'gaze', 'pleasantness' of conversation, 'involvement' in conversation, 'number of questions asked' during conversation, and 'perceived strangeness'. Symptomatology was assessed with the Brief Psychiatric Rating Scale. Ratings of perceived physical attractiveness were obtained by pausing the videotaped role-plays after the first 2s of the interaction. Ratings of 'social distance', based on an independent sample who observed the role-plays, were used as a proxy measure of stigma. The results showed that social distance was best statistically predicted by perceived strangeness, which in turn, was best statistically predicted by ratings of overall social skill. Negative symptoms appeared to have a more robust association with desired social distance than positive symptoms. Interpersonal factors, such as overall social skill, negative symptoms, and perceived strangeness, may contribute to stigma.     

Association between symptoms and quality of life in patients with schizophrenia: a pooled analysis of changes over time

Quality of life is an important outcome in the treatment of patients with schizophrenia. It has been suggested that patients' quality of life ratings (referred to as subjective quality of life, SQOL) might be too heavily influenced by symptomatology to be a valid independent outcome criterion. There has been only limited evidence on the association of symptom change and changes in SQOL over time. This study aimed to examine the association between changes in symptoms and in SQOL among patients with schizophrenia. A pooled data set was obtained from eight longitudinal studies that had used the Brief Psychiatric Rating Scale (BPRS) for measuring psychiatric symptoms and either the Lancashire Quality of Life Profile or the Manchester Short Assessment of Quality of Life for assessing SQOL. The sample comprised 886 patients with schizophrenia. After controlling for heterogeneity of findings across studies using linear mixed models, a reduction in psychiatric symptoms was associated with improvements in SQOL scores. In univariate analyses, changes in all BPRS subscales were associated with changes in SQOL scores. In a multivariate model, only associations between changes in the BPRS depression/anxiety and hostility subscales and changes in SQOL remained significant, with 5% and 0.5% of the variance in SQOL changes being attributable to changes in depression/anxiety and hostility respectively. All BPRS subscales together explained 8.5% of variance. The findings indicate that SQOL changes are influenced by symptom change, in particular in depression/anxiety. The level of influence is limited and may not compromise using SQOL as an independent outcome measure.     

The influence of neurocognitive deficits and symptoms on quality of life in schizophrenia.

The purpose of the present study was to examine the relationship between neurocognitive deficits and self-reported quality of life in order to examine whether neurocognitive impairment interferes with any aspects of quality of life for patients with schizophrenia. Forty-two outpatients with stable chronic schizophrenia were assessed for neurocognitive deficits using a computerized test battery, and all patients completed a version of the Sickness Impact Profile (SIP) to assess their quality of life across a variety of domains. The neurocognitive assessment tests revealed significant deficits compared with normal control subjects, particularly with respect to impaired iconic memory and frontal functioning. Patients reported that their quality of life was compromised. Despite the substantiation of marked neurocognitive deficits and reduced quality of life, correlations between neurocognitive deficits and quality of life were largely nonsignificant or very weak. Symptom expression, however, particularly with regard to general psychopathology on the Positive and Negative Syndrome Scale (PANSS), was significantly associated with quality of life. These results suggest that neurocognitive deficits in schizophrenia, while often profound, appear to have little direct impact on the patient's perceived quality of life.     

男性慢性精神分裂症患者吸烟与精神病理症状关系的研究

目的 探讨吸烟是否可以减少抗精神病药物的副作用,缓解精神分裂症的阴性症状.方法 共纳入376例男性慢性精神分裂症患者,其中吸烟者和非吸烟者各188例,使用Fagerstrom尼古丁依赖量表(FTND)检查尼古丁依赖严重程度.采用阳性和阴性症状量表(PANSS),锥体外系副作用量表和异常不自主运动量表(AIMS)评定患者的精神症状和不良反应.结果 男性慢性精神分裂症吸烟患者PANSS的阴性症状分和帕金森症状分比不吸烟患者显著减少(P=0.008;P=0.02),而吸烟和非吸烟者在PANSS的阳性症状分、一般精神病理症状分和总分以及异常不自主运动量表(AIMS)均无显著性差异(所有P>0.05).结论 吸烟能显著改善慢性精神分裂症的阴性症状,并减轻药物所致的锥体外系副作用,结果支持吸烟是精神分裂症"自我治疗假说".