Quality of life in patients with panic disorder.

In this study we assessed the quality of life of patients with panic disorder, with particular attention to the influence of anxiety and depression comorbidity on quality of life. Findings were compared with established general population norms as well as norms for patients with chronic medical conditions and major depression. The Medical Outcomes Study Short-Form Health Survey (SF-36) was administered to panic disorder patients entering clinical trials or treatment in an outpatient anxiety disorders program. Subjects were 73 consecutive patients with a primary diagnosis of panic disorder without current substance abuse or contributory medical illness. Their quality of life scores were compared with population mean estimates using single-sample t-tests, and the influence of comorbidity was examined with between-group comparisons. All SF-36 mental and physical health subscale scores were worse in patients with panic disorder than in the general population. This was true regardless of the presence of comorbid anxiety or mood disorders, although the presence of the comorbid conditions worsened select areas of functioning according to subscale analyses. SF-36 scores in panic patients were at approximately the same level as patients with major depression and tended to be worse in specific areas than patients with select medical conditions. This study provides evidence of the pervasive negative effects of panic disorder on both mental and physical health.     

Clinical predictors of health-related quality of life in obsessive-compulsive disorder

Background

Obsessive-compulsive disorder (OCD) is a serious mental disorder that has severe impact on a person's quality of life and those living with a person with OCD. This study systematically examined the clinical variables that are predictive of several domains of quality of life in a large, well-characterized sample of patients attending a specialized treatment unit in Italy.

Methods

The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to 151 patients with OCD and their scores were compared to published Italian norms. A principal component analysis was performed on the 13 major categories of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) Symptom Checklist to derive symptom dimension scores. The association between various domains of quality of life and a wide range of clinical variables, including symptom dimension scores, was examined using multiple regression models.

Results

Compared to published Italian norms, patients with OCD showed impairment in most domains of quality of life, particularly social functioning. The principal component analysis of the YBOCS Symptom Checklist yielded 5 symptom dimensions that were identical to those previously identified in the international literature. Fewer years of education, higher depression scores (Hamilton Rating Scale for Depression), higher YBOCS obsessions scores, and higher scores on the contamination/washing symptom dimension independently predicted a poorer score on the physical health component of the SF-36. Higher YBOCS compulsions scores, the presence of a current mood disorder, and higher anxiety scores (Hamilton Rating Scale for Anxiety) predicted a poorer score on the mental health component of the SF-36.

Conclusions

Our study confirms that quality of life is severely impaired in patients with OCD. The identification of predictors of quality of life in OCD can help clinicians to adapt their treatment protocols to cater for the individual needs of their patients.     

首发强迫症患者的生活质量与心理防御机制

目的：探讨首发强迫症患者的生活质量与心理防御机制及其关系。方法：采用健康评定量表（SF-36）和防御方式问卷（DSQ）,对35例首发强迫症患者（患者组）和31名健康对照者（对照组）进行生活质量和心理防御机制的评估。结果：患者组SF-36评分除生理功能（t=0.69,P=0.487）和躯体疼痛（t=1.25,P=0.216）维度外,其他维度（生理职能、总体健康、活力、社会功能、情感职能和精神健康）评分均低于对照组（t=3.41、6.76、6.71、2.01、5.88、7.02,P均〈0.001）。患者组DSQ评分更多的使用不成熟防御机制,更少使用成熟型防御机制（P〈0.01）;不成熟防御机制的使用与躯体疼痛、活力、情感职能和精神健康维度存在显著负相关（r=-0.516、-0.393、-0.378、-0.518,P〈0.05或P〈0.01）;成熟防御机制的使用与总体健康、活力、情感职能和精神健康维度存在显著性正相关（r=0.515、0.441、0.253、0.410,P〈0.05或P〈0.01）。结论：首发强迫症患者较多使用不成熟防御机制,生活质量显著下降,心理防御机制是影响强迫症患者生活质量的因素之一。     

对综合医院神经内科门诊患者焦虑症状群及生活质量的调查

目的调查综合医院神经内科门诊患者焦虑症状群的检出率;探讨神经内科门诊伴有焦虑症状群患者的生活质量。方法使用中文版患者健康问卷(patient health questionnaire,PHQ)、焦虑症状群分量表(GAD-7)及健康状况调查问卷(the short form-36health survey,SF-36)对综合医院神经内科门诊患者进行问卷调查。对受调查患者同时进行生活质量评估,采用Pearson简单相关法对资料进行相关性分析,分析焦虑症状群与生活质量之间的相关性。结果具有焦虑症状群患者97例/306例[31.7%(95%CI:26.5%~36.9%)];具有焦虑症状群的神经内科门诊患者的SF-36各维度评分低于不伴有焦虑症状群患者;SF-36各维度评分与GAD-7评分呈负相关,具有统计学意义。结论在综合医院神经内科门诊就诊者中,焦虑症状群检出率较高;具有焦虑症状群的神经内科患者生活质量较差,尤其以精神健康状况差为显著。     

Health-related quality of life among first-degree relatives of patients with obsessive-compulsive disorder in Italy

OBJECTIVE: The aim of this study was, first, to examine health-related quality of life among relatives of Italian patients with obsessive-compulsive disorder and, second, to search for potential predictors of quality of life among these relatives. METHODS: Health-related quality of life was assessed among 64 non-psychiatrically ill family members of 48 patients with obsessive-compulsive disorder by using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Structured Clinical Interview for DSM-IV Axis II Disorders were used to assess obsessive-compulsive disorder among the patients. Mean SF-36 scores of participants were compared with expected scores for 2,031 persons from the Italian general population (Italian norms) by using the one-sample t test. Correlates of health-related quality of life were examined by means of independent-sample t tests and Pearson correlations; variables significantly associated with SF-36 subscales were entered into a stepwise multiple linear regression analysis with the physical and mental components as dependent variables. RESULTS: Relatives of patients with obsessive-compulsive disorder showed a greater impairment in health-related quality of life in the SF-36 subscales of role limitations due to physical health, vitality, social functioning, role limitations due to emotional problems, and mental health. When a stepwise multiple linear regression analysis was performed with the physical component and the mental component of the SF-36 as dependent variables, female gender, older age, and the total score on the Family Accommodation Scale predicted a poorer score on the physical component, whereas the only predictor of a poorer score on the mental component was the patient's Y-BOCS total score. CONCLUSIONS: The study provides evidence that obsessive-compulsive disorder impairs health-related quality of life among family members of patients with obsessive-compulsive disorder, even among healthy family members. Involving family members in the treatment of obsessive-compulsive disorder could improve their perceived quality of life.     

Clinical significance of lifetime mood and panic-agoraphobic spectrum symptoms on quality of life of patients with rheumatoid arthritis

BACKGROUND: Previous studies suggested that rheumatoid arthritis (RA) is associated with depressive and anxiety symptomatology. The well-being and functioning of patients with RA may be significantly influenced by subthreshold psychiatric comorbidity. Health-related quality of life (HRQoL) of patients with RA, compared with the Italian norms and patients with diabetes, was assessed by the influence of lifetime mood and panic-agoraphobic spectrum symptoms and demographic and clinical variables. METHODS: Ninety-two patients were consecutively recruited at the Department of Rheumatology at the University Hospital of Pisa, Italy. All patients met diagnostic criteria of RA according to the American College of Rheumatology. Health-related quality of life was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (MOS SF-36). Mood and panic-agoraphobic spectra were assessed by two different structured self-report instruments: the Mood Spectrum (MOODS-SR) and the Panic-Agoraphobic Spectrum (PAS-SR), respectively. RESULTS: Patients with RA were compared, as regards the MOS SF-36 scale scores, with the Italian normative population and patients with diabetes. Compared with the Italian population, patients with RA showed significantly lower MOS SF-36 scale scores, except for role emotional. Moreover, patients with RA scored significantly lower on the role physical, bodily pain, and social functioning scales compared with patients with diabetes and higher on role emotional and mental health. A significant worsening of all MOS SF-36 scale scores was related to higher scores of the depressive domains of MOODS-SR, except for social functioning and bodily pain. A statistically significant negative association was also found between PAS-SR total score and the MOS SF-36 scales physical functioning, vitality, role emotional, and mental health. There were no statistically significant correlations between MOS SF-36 scales and the manic MOODS spectrum. In the multivariate models, the negative correlations between depressive MOODS, role emotional, and mental health were confirmed and the severity of arthritis showed a significant impact on all MOS SF-36 areas with the exception for social functioning; moreover, manic MOODS was associated with better general health. CONCLUSIONS: The present report shows that lifetime depressive spectrum symptoms negatively affects HRQoL of patients with RA and subthreshold mania improves the perception of general health. Diagnosis and appropriate clinical management of depression, including subthreshold symptoms, might enhance HRQoL in these patients.     

Quality of life in Friedreich ataxia: what clinical,social and demographic factors are important?

The aim of this study was to examine the impact of Friedreich ataxia (FRDA) on quality of life (QOL) using a generic tool to explore factors potentially associated with health status. Sixty-three individuals with genetically confirmed FRDA, self completed the Medical Outcomes Study 36 item Short Form Health Survey Version 2 (SF-36V2) and were assessed using the FRDA Rating Scale. Disease-specific, demographic, and social characteristics were also recorded. SF-36V2 results were compared with Australian population norms. Sample subgroups of disease severity and age at disease onset were reviewed. Physical and mental component summaries were examined in relation to clinical and social characteristics using multiple linear regression. QOL is significantly worse in individuals with FRDA compared with population norms. Those with severe disease did not perceive a lower QOL than those with mild or moderate disease except in their physical functioning. A later age of onset and increased disease severity were negatively associated with physical QOL, whilst, increased disease duration was positively associated with mental QOL. There were limitations associated with the use of SF-36V2 in the FRDA population. Further exploration of health-related QOL and FRDA may benefit from the use of a more appropriate generic tool.     

Quality of life in social anxiety disorder compared with panic disorder and the general population

OBJECTIVE: Quality of life in a treatment-seeking cohort of patients with social anxiety disorder was compared with that of patients with panic disorder who were matched for age, comorbid illnesses, and gender and with population-based norms. METHODS: The study participants were 33 patients with social anxiety disorder and 33 patients with panic disorder who had participated in clinical trials and who had completed the Medical Outcomes Study Short-Form-36 (SF-36) as part of a baseline evaluation. The patients did not have significant comorbid psychiatric disorders. Paired t tests were used to compare baseline scores on subscales of the SF-36 between the two cohorts. One-sample t tests were used to compare scores on subscales of the SF-36 with expectation scores based on 2,474 persons from the general population. RESULTS: Compared with the general population, the patients with social anxiety disorder had significantly greater impairment as measured by the SF-36 social functioning and mental health subscales. Subscale scores also indicated poorer emotional role functioning, but the difference was not significant. However, they were significantly less impaired than the patients with panic disorder in terms of physical functioning, physical role, and mental health. CONCLUSIONS: Patients with social anxiety disorder who do not have significant comorbid depression or anxiety are substantially impaired in quality of life, but to a lesser extent than patients with panic disorder, who suffer from both mental and physical impairments in quality of life.     

抑郁障碍的家庭负担——山东省的研究

目的 了解山东省抑郁障碍患者的家庭负担情况.方法 在山东省范围内收集900例抑郁障碍患者,以家庭负担问卷(FBS)评价家庭负担,以家庭关怀度指数问卷(APGAR)评价家庭功能,以健康状况问卷(SF - 36)评定照料者的生活质量和心理负担,并与正常人家庭对照.结果 在FBS的6个因子中,家庭经济负担、家庭日常活动...     

The impact of posttraumatic symptoms and comorbid mental disorders on the health-related quality of life in treatment-seeking PTSD patients

BackgroundThere is a dearth of literature dealing with the impact of the severity of posttraumatic symptoms and of comorbid mental disorders on the health-related quality of life (HRQOL) of victims of civilian violence with a primary diagnosis of PTSD.ObjectivesTo investigate the influence of the severity of posttraumatic symptoms and of presence of comorbid mental disorders on the HRQOL of treatment-seeking outpatients with PTSD.MethodsA sample of 65 PTSD patients was recruited in a specialized outpatient clinic. The volunteers had the diagnoses of PTSD and of comorbid mental disorders established with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The severity of posttraumatic, depression and anxiety symptoms was measured with the PCL-C, BDI and BAI, respectively. HRQOL was assessed by means of the SF-36, a 36-item self-administered scale that measures eight domains of quality of life: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. Multiple linear regression models were fitted to investigate the relationship between the severity of posttraumatic, mood, and anxiety symptoms; the presence of specific current comorbid disorders and of psychotic symptoms, and the number of current comorbid conditions for each of the eight domains of HRQOL, after adjusting for the effect of sociodemographic characteristics.ResultsThe severity of PTSD symptoms predicted worse HRQOL in all eight domains of SF-36, even after controlling for the severity of depression and anxiety symptoms, the presence of panic disorder, OCD, specific and social phobia, psychotic symptoms, and the number of comorbid disorders. The strongest negative association between PTSD symptoms severity and HRQOL was found in the Social Functioning domain. Although the inclusion of the depressive symptoms in the models led to a reduction of the magnitude of the negative association between the severity of PTSD symptoms and the HRQOL domain scores, the former still accounted for most of the explained variance of the latter.ConclusionsWe found that even in the presence of comorbid mental disorders, the severity of posttraumatic symptoms remained the strongest predictor for impaired HRQOL in PTSD outpatients. Our results suggest that improvement of HRQOL should be considered a therapeutic objective and an essential outcome measure in the treatment of PTSD.     

Relationships between disability, quality of life and prevalence of nonmotor symptoms in Parkinson's disease

Patients with Parkinson's disease suffer from a variety of motor and nonmotor symptoms (NMS), report reduced quality of life and increased disability. Aims of this study are to assess the impact of Parkinson's disease on disability and quality of life, to evaluate the relationships between them and NMS prevalence. In this cross-sectional study, adult patients were consecutively enrolled and administered the World Health Organization Disability Assessment Schedule (WHO-DAS II), the 36-Item Short-Form Health Survey (SF-36) and the Non Motor Symptoms Questionnaire (NMSQuest). One-sample t-test was used to compare WHO-DAS II and SF-36 scores with normative value. Pearson's correlation was performed between NMSQuest, WHO-DAS II and SF-36 summary scales. Independent-sample t-test was used to compare NMSQuest, WHO-DAS II and SF-36 scores in patients with Hoehn & Yahr stage <3 and ≥ 3. In total, 96 patients were enrolled. SF-36 and WHO-DAS II scores were significantly worse than the normative values. Correlation coefficients between NMSQuest, WHO-DAS II and SF-36's mental score were moderate, and were high between WHO-DAS II and and SF-36's physical score. Patients with Hoehn & Yahr stage ≥ 3 reported reduced quality of life, higher disability and more NMS. Parkinson's disease severity is strongly associated with reduced quality of life, increased disability and NMS prevalence. Disability and quality of life assessment tools measure psychosocial facets that are similar specifically with regard to physical health component of health-related quality of life, are sensitive enough to capture differences related to disease's progression and increased prevalence of NMS.     

精神分裂症伴肺结核患者生活质量与心理健康的相关分析

目的探讨精神分裂症伴肺结核患者的生活质量、心理健康状况及其相互关系。方法采用世界卫生组织生活质量量表（WHOQOL-100）和症状自评量表（SCL-90）,对53例精神分裂症伴肺结核患者进行评定,并与53例精神分裂症患者资料进行对照比较。结果精神分裂症伴肺结核组WHOQOL-100总分以及心理领域、独立性领域、社会关系领域、精神支柱领域评分均明显低于对照组（P〈0．05）。精神分裂症伴肺结核组SCL-90总分以及躯体化、人际关系敏感、抑郁、焦虑、恐怖因子分均高于对照组,差异具有显著性（P〈0．05～0．01）。WHOQOL-100总分与SCL-90躯体化、人际关系敏感、抑郁、焦虑、恐怖、精神病性等因子分呈负相关（P〈0．05）。结论精神分裂症伴肺结核患者较不伴肺结核患者的生活质量和心理健康状况更差,二者关系密切。应重视改善他们的心理健康状况和生活质量。     

Using the SF-36 measure to compare the health impact of multiple sclerosis and Parkinson's disease with normal population health profiles

OBJECTIVE: To examine the relative impact of two chronic neurological disorders, multiple sclerosis and Parkinson's disease, by comparing patients' scores on the medical outcomes study 36-item short form health survey (SF-36) with the health profile of the United Kingdom population norms. METHODS: 638 people representing the full spectrum of multiple sclerosis and 227 patients with Parkinson's disease were studied. Health status was measured by the SF-36. Scores for the eight health domains were compared after controlling for age, sex, disease duration, mobility, social class, ethnicity, education, marital status, and employment status. RESULTS: People with multiple sclerosis and those with Parkinson's disease had significantly worse health than the general population on all eight domains measured by the SF-36. The relative impact of multiple sclerosis and Parkinson's disease were similar, but multiple sclerosis resulted in poorer scores on physical functioning and better scores in mental health. People with mild multiple sclerosis who walked without an aid also had significantly worse scores in all dimensions than the general UK population. CONCLUSIONS: The results highlight the need for further research into aspects of health measured by the SF-36. Nevertheless, generic measures that are applicable across multiple diseases may fail to address clinically important aspects of the impact of specific disorders.     

强迫症患者生活质量和社会支持情况调查

目的:了解强迫症患者生活质量与社会支持情况,并分析二者的相关性. 方法:对91例符合DSM-Ⅳ诊断标准的强迫症患者及92名健康对照者实施健康状况问卷(SF-36)与社会支持评定量表(SSRS)评估. 结果:强迫症患者SF-36各维度评分、SSRS总分及各维度评分均低于正常对照人群(P ＜0.05或P＜0.01);社会支持量表总分与躯体疼痛(r=0.276,P=0.009)、情感职能(r=0.234,P=0.028)存在相关;客观支持与情感职能(r=0.242,P=0.021)、躯体疼痛(r=0.257,P=0.015)存在相关;主观支持与躯体疼痛(r =0.220,P=0.037)存在相关. 结论:强迫症患者生活质量和社会支持低于正常人群,其生活质量与社会支持有关联.     

How do scores on the EuroQol relate to scores on the SF-36 after stroke?

BACKGROUND AND PURPOSE: The EuroQol and Medical Outcome Survey 36-item short-form health survey (SF-36) questionnaires have both been validated for the assessment of health-related quality of life after stroke. However, the relationship between these instruments has not been studied after stroke. We therefore sought to compare the responses of a group of stroke patients to both instruments. METHODS: A total of 2253 patients with stroke entered by United Kingdom hospitals in the International Stroke Trial were randomized to follow-up with either the EuroQol or SF-36 instruments. We randomly selected one third of patients who had responded to the EuroQol for follow-up, again using the SF-36, and two thirds of patients who had responded to the SF-36 for follow-up, again using the EuroQol. We assessed the patients' mean score for each domain of the SF-36 categorized by their response to the corresponding EuroQol domain and the correlation between the domains of the 2 instruments. RESULTS: The domains for both instruments, which assessed physical functioning, social functioning, bodily pain, and overall health-related quality of life, correlated closely. The mental health domain of the SF-36 correlated only poorly with the psychological functioning domain of the EuroQol. CONCLUSIONS: Both the EuroQol and SF-36 measure broadly similar domains of health. The weak relationship between the assessments of mental health may reflect a difference in content or more fundamental problems with the validity or reliability of the items in one of the instruments with respect to this domain. This study has provided the first empirical qualitative evidence by which the data on the SF-36 after stroke may be interpreted.     

Deterioration in the health-related quality of life of persons with multiple sclerosis: the possible warning signs

Baseline data from a population-based study examining the health-related quality of life (HRQL) of MS patients about to begin disease modifying therapy was used to determine the factors associated with the HRQL of Saskatchewan adults with relapsing-remitting MS. Participants completed a self-report questionnaire regarding demographic and socioeconomic status, fatigue, comorbid medical conditions, disability level (EDSS), number of attacks in past 6 months, illness intrusiveness (Illness Intrusiveness Ratings Scale), depression (Beck Depression Inventory), and HRQL (SF-36 Health Status Survey). Multiple linear regression models were used to identify the factors associated with the physical and mental health summary scores of the SF-36. We found poorer physical HRQL in those who are female; older; not working; have musculoskeletal or respiratory problems; greater fatigue, higher disability scores, and more MS attacks. High illness intrusiveness; digestive system problems; genitourinary problems; and headaches were associated with poorer mental HRQL. Interestingly, we found an interaction between sex and age in mental HRQL, with worse mental health in older men but better mental health in older women. These findings may assist health care providers in identifying patients who may be at risk for decline in their HRQL, permitting appropriate and timely interventions.     

Correlation between regional myasthenic weakness and mental aspects of quality of life

Here we report how the different types of regional muscle involvement, i.e. bulbar, ocular or generalized, in patients with myasthenia gravis (MG) influence the mental aspects of quality of life. Clinical examination according to Osserman was performed in 48 MG patients (45 women, three men; mean age 54, SD 12 years). Each patient was at the time for clinical evaluation asked to fill out the disease-specific Myasthenia Gravis Questionnaire (MGQ) and the Short-Form 36-item questionnaire for health survey (SF-36) as patient-oriented tools. We related the regional domains (generalized domain, bulbar domain and ocular domain) of the MGQ and the clinical findings, respectively, with mental quality of life as assessed by SF-36. Bulbar and generalized involvement results in impairment of mental aspects of quality of life, whereas ocular involvement does not.     

Health-related quality of life in segmental dystonia is improved by bilateral pallidal stimulation

In contrast to generalized dystonia, reports on the effectiveness of pallidal stimulation on quality of life in patients with segmental dystonia are sparse to date. In ten patients with idiopathic segmental dystonia we prospectively evaluated the effect of pallidal stimulation on quality of life using the SF-36 questionnaire. Parallel to the improvement of motor scores, total SF-36 scores and physical and mental health subscores improved significantly at follow-up to a mean of 17 months postoperatively. Thus, pallidal stimulation should be recognized as a promising treatment option in patients with segmental dystonia.