Quality of life in schizophrenia and dysthymia

Quality of life (QOL) was assessed in three groups of patients, consisting of 30 schizophrenic patients with duration of illness < 2 years, 30 schizophrenic patients with duration of illness ≥2 years and 30 dysthymic patients. The diagnoses were made according to ICD-10. Two scales of quality of life were used, one of which was specific for schizophrenia, while the other was generic for all patients. On inter-group comparison the two schizophrenia groups did not show significant differences in quality of life, but on comparing schizophrenic and dysthymic patients, significant differences emerged. Dysthymic patients were significantly less satisfied than schizophrenic patients with duration of illness < 2 years in the domain of physical health. In the domains of satisfaction with medication and leisure-time activities, both schizophrenic groups were significantly more satisfied than the dysthymic group. Comparison of the quality of life ratings of our patients with those of a well-known study from Sweden revealed some significant differences which relate to the domains of work, contacts, inner experience and leisure-time activities. Cultural factors are invoked to account for these differences. The need for refinement of assessment of quality of life in multi-racial and multi-ethnic contexts is stressed.     

Are importance ratings useful in the assessment of subjective quality of life in schizophrenic patients?

Subjective quality of life (QOL) is predominantly measured as satisfaction in various life domains. However, this approach has often been criticized for not taking individual preferences into account. A combination of importance and satisfaction ratings allows for the different weights that different life domains have in a person's QOL. The present study aimed to investigate empirically the usefulness of combined satisfaction and importance ratings in the assessment of schizophrenic patients. In a cross-sectional study, 149 schizophrenic patients and 106 healthy controls rated their satisfaction with and the importance of 19 different life domains. Results of multidimensional scaling suggested that satisfaction and importance ratings tap different concepts in mentally healthy controls and schizophrenic patients. However, as compared with satisfaction ratings, importance ratings were even more shifted towards the positive pole of the scale and showed less variance. Very high correlations were found between the pure and the weighted satisfaction scores. No additional variance could be accounted for with regard to psychopathology, age or sex. Although a combination of satisfaction and importance ratings fits better with the subjective concept of QOL on a theoretical level, the results of this study do not support the application of this model in QOL assessment in schizophrenic patients. Copyright © 1999 Whurr Publishers Ltd.     

Chronic Pain and Quality of Life in Schizophrenic Patients

ObjectiveTo identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain.MethodsCrossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia). Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief) data were collected between June and September 2008.ResultsMean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001). There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them.ConclusionChronic pain was common in schizophrenic patients (similar to the general population of a similar age) and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.     

齐拉西酮对慢性精神分裂症患者生活质量的影响

目的比较齐拉西酮与舒必利治疗对精神分裂症患者生活质量的影响。方法将88例慢性精神分裂症患者随机分为2组各44例,分别给予齐拉西酮和舒必利治疗,疗程12周。用生活质量综合评定问卷(GQOLI)、阳性与阴性症状量表(PANSS)、副反应量表(TESS)评定疗效及不良反应。结果齐拉西酮能明显提高慢性精神分裂症患者的生活质量,在改善GQOLI总分、躯体健康、心理健康及社会功能维度优于舒必利。结论齐拉西酮治疗有利于慢性精神分裂症患者生活质量的提高,临床应用安全。     

Symptomatology differentials between urban and rural schizophrenics

The frequency of symptoms between urban and rural schizophrenic patients was compared in 275 consecutive admissions of schizophrenics, who were rated on two rating scales by psychiatrists, using a structured interview. There were significant differences between urban and rural schizophrenics; rural patients were more frequently apathetic, blunted, labile, angry, aggressive, negativistic and uncooperative, while urban schizophrenics were more often anxious, rigid, ambivalent, disoriented, conceptually disorganised and asocial. Significant symptom differences were also found for only older or younger schizophrenics.     

Objective and subjective quality of life of first-admitted women and men with schizophrenia

Empirical studies have shown that there are differences between women and men with respect to the onset of schizophrenia and the development of their mental and social conditions. It was therefore the goal of this study to assess the objective life situation and subjective quality of life, as well as the differences, similarities and interrelations, at the onset of schizophrenia in women and men. Ninety schizophrenic patients were interviewed between the second and fourth weeks of their first hospital stay using the Berlin Quality of Life Profile, and rated according to the BPRS. Areas of social problems (work, living circumstances, safety and drug abuse) had become manifest with several of the patients, particularly among the young men, prior to first admission. Although objective conditions, gender and psychopathology have an impact on the subjective quality of life, it cannot be fully explained by them. Multivariate analyses have demonstrated that the factors influencing it are probably different for women and men, and schizophrenic women appraise their life circumstances in a different manner from men, as is true for differences between the statements of acutely and chronically ill patients. It can be concluded from the results of this study that psychiatric services should offer specific social support measures before or at first hospital admission and not after the illness has become chronic. The subjective construct of global quality of life apparently differs from one sample to another, and gender-related aspects, among others, have an impact on it. Received: 2 June 1997 / Accepted: 14 July 1998     

利培酮与氯氮平治疗精神分裂症患者生活质量对照研究的meta分析

目的 比较利培酮与氯氮平治疗精神分裂症患者疗效及对生活质量的影响。方法对包括988例 精神分裂症患者的8篇中国文献进行meta分析,其中利培酮组共计501例,氯氮平组487例。结果2组治疗后的 有显著疗效,但组间比较疗效差异无显著性意义。对采用WHOQOF-100量表中文版的5个调查资料综合分析后 发现:与氯氮平组相比,利培酮组患者的生活质量除生理领域略差外,其他领域及生活质量总体状况均优于氯氮平 组;失效安全数在17．25～311．23之间,可靠性好。对采用生活质量综合评定问卷(GQOLI)的4个调查资料综合分 析后发现:2组患者在物质生活维度无显著性差异,利培酮组在其他3个维度较氯氮平组好;除物质生活维度外,失 效安全数在74．39～94．39之间,可靠性较好。结论氯氮平和利培酮对精神分裂症均有较好的疗效,利培酮的比 氯氮平更有利于改善精神分裂症患者的社区康复功能,有利于患者重返社会。     

The quality of life of chronic schizophrenic patients in their own and their family's assessment

The aim of the research was to analyse the subjective quality of life of chronic, schizophrenic patients. The patients' quality of life was compared to the evaluation of their family. They evaluate the quality of life similarly. The differences concern the relationship between the quality of life and clinical characteristics.     

Factors explaining career satisfaction among psychiatrists and surgeons in Canada.

BACKGROUND: The career satisfaction of specialists is affected by many variables ranging from family responsibilities, stress, the quality of services and facilities available to patients, professional rewards, and how the work is organized. OBJECTIVE: To articulate models that explain a substantial portion of the variance associated with career satisfaction among surgeons and psychiatrists in Canada. METHODS: Of 4958 eligible physicians across Canada, 2810 (56.7%) completed a 12-page survey between January and March 2004, following which the responding 148 surgeons and 231 psychiatrists were selected for this study. We checked response bias and found it was negligible. Hierarchical regression analysis was used to record cumulative R2, Standardized beta, and significance levels as each predictor was entered. We applied weighting factors to reflect the actual physician population in Canada. RESULTS: The models explained 90.4% of the variance in career satisfaction for surgeons and 81.0% of the variance in career satisfaction for psychiatrists. The explanatory variables consisted of distress and coping, role in community activities, access to and quality of health care services, intrinsic and extrinsic rewards, workload, and organizational structure. CONCLUSIONS: The study demonstrated that variance associated with career satisfaction can be explained using various factors reported directly by physicians. The study also confirmed that relative differences in the importance of these factors do occur among specialties. Surgeons prefer to delegate more responsibility in the management of their practices on an informal basis, whereas psychiatrists prefer to be more involved in the management of their practices and use more formal structures.     

Quality of life in schizophrenic patients: Association with depressive symptoms

The objective of this study was to examine to what extent depressive symptoms are associated with reduced quality of life in schizophrenia by using a general population sample as control group. Patients with ICD-10 schizophrenia stabilized during hospitalization with antipsychotics were compared with a general population sample by use of self-reported scales for quality of life (the WHO Quality of Life Short Form, WHOQOL- BREF) and for depression (the Major Depression Inventory, MDI). Of the schizophrenic patients screened for ability to participate in the study, 40, or 71%, completed the two questionnaires as psychometrically valid as the control group. Within the group of schizophrenic patients, no association was seen with the types of antipsychotic medication prescribed (typical vs. atypical antipsychotics). Both in the group of schizophrenic patients and in the general population sample, those persons scoring on the MDI to have depressive symptoms had significant reduced quality of life. In conclusion, approximately 70% of the schizophrenic patients stabilized during hospitalization with antipsychotics are able to validly complete self-report scales measuring quality of life and depressive symptoms. In these patients, depressive symptoms, as in the general population, was found to have association with reduced quality of life.     

Quality of life in schizophrenic patients: association with depressive symptoms

The objective of this study was to examine to what extent depressive symptoms are associated with reduced quality of life in schizophrenia by using a general population sample as control group. Patients with ICD-10 schizophrenia stabilized during hospitalization with antipsychotics were compared with a general population sample by use of self-reported scales for quality of life (the WHO Quality of Life Short Form, WHOQOL- BREF) and for depression (the Major Depression Inventory, MDI). Of the schizophrenic patients screened for ability to participate in the study, 40, or 71%, completed the two questionnaires as psychometrically valid as the control group. Within the group of schizophrenic patients, no association was seen with the types of antipsychotic medication prescribed (typical vs. atypical antipsychotics). Both in the group of schizophrenic patients and in the general population sample, those persons scoring on the MDI to have depressive symptoms had significant reduced quality of life. In conclusion, approximately 70% of the schizophrenic patients stabilized during hospitalization with antipsychotics are able to validly complete self-report scales measuring quality of life and depressive symptoms. In these patients, depressive symptoms, as in the general population, was found to have association with reduced quality of life.     

Stettegrupper for skizofrene patienters forældre

Contact between psychiatrists and the patient's family have become of current importance after Julian P. Leff and others of his contemporaries have proved that psychosocial interventions in the environment of the patient can have a positive influence on the course of schizophrenia. This article recounts what we have learned from inviting the relatives of schizophrenic patients to attend group meetings, the purposes of which were 1) to create better contact with the ward and 2) to get relatives to talk about mutual problems. Until then the parents' experience with the psychiatric services had been most unsatisfactory. The dominant theme in the current meetings was the feeling of relief at finding fellow sufferers. Information about schizophrenia and discussions about expedient patterns of behaviour when in the company of schizophrenic patients were two equally important subjects. The parents showed their approval by very regular attendance of the meetings but stated at the final evaluation that they would like further information and behaviour training. The professional received a first-hand impression of the burden the schizophrenic families have felt obliged to carry and the lack of professional support they have experienced. We believe that the supervision, the education, and the behaviour training of the family can be improved with the current decentralisation of psychiatric services.     

Frequency and effects of psychosocial interventions additional to olanzapine treatment in routine care of schizophrenic patients

Background Guidelines for the treatment of schizophrenia recommend the combination of pharmacologic and psychosocial interventions. There is a lack of data on the utilization and effects of psychosocial interventions additional to neuroleptic treatment in routine care of schizophrenic patients. Method In a drug utilization study 495 psychiatrists documented patient and disease characteristics of 1,711 schizophrenic outpatients treated with olanzapine. Data were recorded at five visits during an observation period of 6 months. Results Psychosocial interventions were reported in 30% of all patients. Compared to patients who were treated with olanzapine alone (nPSI), patients receiving psychosocial interventions (PSI) were more likely to be unmarried and unemployed, and showed significantly higher impairment on relevant psychopathological and psychosocial parameters (e.g. PANSS, GAF, LQLP). After 6 months of treatment with olanzapine patients improved significantly in respect to their schizophrenic symptoms, psychosocial functioning, and quality of life. Patients receiving psychoeducation showed a higher degree of improvement than the other patients. They were more ill at the beginning of the study, but less ill at the end of the study. Patients receiving psychoeducation showed a trend to better medication compliance. Conclusions The data suggest that psychosocial interventions are a frequently used mode of treatment especially for severe cases of schizophrenia Psychoeducation appears to be especially effective for this patient group with a positive impact not only on psychosocial but also on psychopathological criteria of outcome.     

Quality of life of schizophrenic patients on medications and implications for new drug trials.

The quality of life of schizophrenic patients participating in clinical trials of new neuroleptics is rarely systematically assessed. Factors that may have contributed to the neglect of such assessments include the difficulty of measuring changes affecting quality of life during short-term trials and the continued belief that schizophrenic patients' self-reports about inner states are unreliable. A model of determinants specifically related to the quality of life of schizophrenic patients in such trials would include symptoms, side effects of neuroleptics, and psychosocial performance. In view of the importance of assessing the quality of life of patients on medications, the author recommends that regulatory agencies require such assessments in clinical trials of new neuroleptics.     

Negative Symptome schizophrener Patienten aus der Perspektive der Psychiater,der Patienten selbst und deren Angehörigen

Clinical experience shows that negative symptoms are affected by environmental factors. Thus, different assessors with different information about patient behavior in different environments may come to different findings of negative symptoms. In this regard, the present study evaluates to what extent the assessment of negative symptoms by schizophrenic inpatients and their relatives compares to interview-based assessments by experts. Therefore, 33 schizophrenic patients were rated by patients themselves, their relatives, and psychiatrists. Negative symptoms were assessed with comparable assessment scales using the modified version of the Scale for the Assessment of Negative Symptoms (SANS) for patients or relatives and the original SANS for psychiatrists. Analyses revealed that the total SANS summary scores as rated by patients and relatives were comparable to scores rated by psychiatrists. Scores on SANS subscales of "alogia" and "attention deficits" differed significantly among the three ratings, while psychiatrists rated the patients' impairments as lower than did the patients themselves or their relatives. These findings indicate that patients' and relatives' ratings could be used to reduce information variance and improve the validity of interview-based, assessed negative symptoms.     

Providing patients with information about treatment choices: do unto others?

A variety of internal and external pressures may lead psychiatrists to promote intensive or intrusive treatments. However, when asked what treatment they would want for themselves they seem more likely to opt for less intensive treatments or no treatment at all. These differences highlight the importance of providing patients with enough information to enable them to make a fully informed choice about the treatment they receive.     

Clinical judgement on alternative care for longstay patients in Dutch mental hospitals

How many longstay patients could be equally served by less sheltered facilities, and what are the main reasons for staff members to judge patients suitable for such alternative care? These were two questions in a Dutch study (1984-1985) of five mental hospitals. The attending psychiatrists in these hospitals and members of the nursing staff, were asked to give an independent judgement for each of a random sample of 381 longstay patients. Thirty percent of the longstay patients were judged eligible for alternative care. They were generally younger, less frequently diagnosed as schizophrenic, better integrated both inside and outside the mental hospital, more likely to be resident of wards with high turnover rates, were less aggressive, had better social skills, and had shorter periods of inpatient stay. Compared with the rest of the patients no statistically significant differences were found with regard to suicidal behaviour, organic brain syndrome and formal admission status.     

Christian Psychiatry: the impact of evangelical belief on clinical practice

OBJECTIVE: The authors surveyed psychiatrists in the Christian Psychiatry movement to assess the role of religious belief in their practices. METHOD: The psychiatrists were members of the Christian Medical and Dental Society; questionnaires were sent to 260, and usable responses were received from 193. The subjects were asked about demographic and practice variables, "born again" religious experiences, group cohesion, and beliefs about using the Bible and prayer in treatment. RESULTS: The respondents were somewhat more religious than Americans overall, who are themselves more religious than most psychiatrists. Nearly all reported having been "born again," after which they generally experienced a decrease in emotional distress. There was a significant difference in the respondents' affiliative feelings toward psychiatrists in the Christian Psychiatry movement and other psychiatrists. For acute schizophrenic or manic episodes, the respondents considered psychotropic medication the most effective treatment, but they rated the Bible and prayer more highly for suicidal intent, grief reaction, sociopathy, and alcoholism. Whether or not a patient was "committed to Christian beliefs" made a significant difference in whether the respondents would recommend prayer to the patient as treatment. About one-half said they would discourage strongly religious patients from an abortion, homosexual acts, or premarital sex, and about one-third said they would discourage other patients from these activities. CONCLUSIONS: Many studies have suggested a need for more sensitivity to religious issues by psychiatrists, and this study provides systematic findings on one approach. It remains important to evaluate ways in which a religious perspective can be related to clinical practice and what benefits and problems may derive from such a relationship.     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。