A conceptual model of quality of life in schizophrenia: Description and preliminary clinical validation
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The utility of quality of life (QOL) as an evaluative tool in clinical psychiatric research and drug trials could be enhanced by developing appropriate conceptual models of QOL, specific for psychiatric disorders. In our proposed model, QOL of individuals maintained on antipsychotic drug therapy for schizophrenia, is viewed as the subject's perception of the outcome of an interaction between severity of psychotic symptoms, side-effects including subjective responses to antipsychotic drugs, and the level of psychosocial performance. In order to test the validity of the model in clinical setting, we selected a sample of 62 schizophrenic patients clinically stabilized on antipsychotic drug therapy, and measured their subjective QOL and other potentially relevant clinical and psychosocial factors. Standardized scales including the positive and negative syndromes scale (PANSS), abnormal involuntary movements scale (AIMS), Hillside Akathisia scale (HAI), and the social performance schedule (SPS) were used for this purpose. Results of a multiple regression analysis using subjective quality of life as the outcome variable, indicated that severity of schizophrenic symptoms (partial R2=0.32, p < 0.0001) and subjective distress caused by akathisia (partial R2=0.11, p < 0.01) and neuroleptic dysphoria (partial R2=0.06, p < 0.05), accounted for nearly half of the variance, while the contribution from the psychosocial indicators was negligible. These results broadly endorse key aspects of the proposed model, and suggest further studies in this direction. These results suggest that improvement in patients' subjective experiences during antipsychotic therapy can enhance patients' QOL. This conceptual model has been developed with particular focus on the impact of antipsychotic medications on the QOL of persons with schizophrenia. As such, it is more applicable to clinical trials of new antipsychotic medications but may not be broad enough to be applicable for other social or vocational interventions.
- Meltzer HY, Burnett S, Bastani B, et al. Effects of six months of clozapine treatment on the quality of life of chronic schizophrenic patients. Hosp Comm Psychiatry 1990; 41: 892-897.
- Awad AG, Voruganti LNP, Heslegrave RJ. Measurement of quality of life in schizophrenia. PharmacoEconomics (in press)
- Lancet. Quality of life and clinical trials. Lancet 1995; 346: 1-2.
- Awad AG. Quality of life of schizophrenic patients on medications and implications for new drug trials. Hosp Comm Psychiatry 1992; 43: 262-265.
- Awad AG. Methodological and design issues in clinical trials of new neuroleptics: an overview. Br J Psychiatry 1993; 163(Suppl. 22): 51-57.
- Awad A. Quality of life issues in medicated schizophrenics: therapeutic and research implications. In: Contemporary Issues in the Treatment of Schizophrenia. Shariqui CL, Nasrallah H, eds. Washington DC: American Psychiatric Press, 1995.
- Lehman A, Ward N, Linn L. Chronic mental patients: the quality of life issue. Am J Psychiatry 1982; 139: 1271-1276.
- Lehman A. The well-being of chronic mental patients: assessing their quality of life. Arch Gen Psychitatry 1983; 40: 369-373.
- Lehman A. The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill. Eval Prog Plan 1983; 6: 143-151.
- Lehman A, Possidente S, Hawker F. The quality of life of chronic patients in a state hospital and in community residences. Hosp Comm Psychiatry 1986; 37: 901-907.
- Sullivan G, Wells K, Leake B. Quality of life of seriously mentally ill persons in Mississippi. Hosp Comm Psychiatry 1991; 42: 752-754.
- Levitt AJ, Hogan TP, Bucosky CM. Quality of life in chronically mentally ill patients in day treatment. Psychological Med 1990; 20: 703-710.
- Corten P, Mercier C, Pelc I. "subjective quality of life’: clinical model for assessment of rehabilitation treatment in psychiatry. Soc Psychiatry Psychiatr Epidemiol 1994; 29: 178-183.
- Gill T, Feinstein A. A critical appraisal of the quality of life measurements. JAMA 1994; 272: 619-626.
- Kay S, Fiszbein A, Opler L. The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schiz Bull 1987; 13: 261.
- Fleishhacker WW, Bergmann KJ, Perovich R, et al. The Hillside Akathisia Scale: A new rating instrument for neuroleptic induced akathisia. Psychopharm Bull 1989; 25: 222-226.
- Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Washington DC: US Department of Health, Education and Welfare, 1976.
- Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychological Med 1983; 13: 177-183.
- Hogan T, Awad A. Subjective response to neuroleptics and outcome in schizophrenia: A re-examination comparing two measures. Psychological Med 1992; 22: 347-352.
- Wykes T, Stuart E. The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS schedule. Br J Psychiatry 1986; 148: 1-11.
- Endicott J, Spitzer RL, Fleiss JL, et al. The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 766-771.
- Gurin G, Verhoff J, Feld S. Americans View Their Mental Health. New York, NY: Russel Sage Foundation, 1960.
- Bachrach L. Deinstitutionalization: An Analytic Review and Sociological Perspective. Rockville, MD: National Institute of Mental Health, 1976.
- Strauss JS. Subjective experiences of schizophrenia: towards a new dynamic psychiatry. Schiz Bull 1987 15: 178-179.
- Singh MM, Kay SR. Dysphoric response to neuroleptic treatment in schizophrenia: its relationship to autonomic arousal and prognosis. Biolog Psychiatry 1979; 14: 277-294.
- Van Putten T, May PRA, Marder SR. Subjective response to thiothixene and chlorpromazine. Psychopharma Bull 1980: 16-18.
- Awad AG, Hogan TP. Early treatment events and prediction of response to neuroleptics in schizophrenia. Prog Neuropsychopharma Biolog Psychiatry 1985; 9: 585-588.
- VanPutten T, May PRA, Marder SR, et al. Subjective response to antipsychotic drugs. Arch Gen Psychiatry 1981; 38: 187-190.
- Diamond R. Drugs and quality of life: The patient's point of view. J Clin Psychiatry 46(5): 29-35.
- Awad AG. Subjective response to neuroleptics in schizophrenia. Schiz Bull 1993; 19: 609-617.
- Awad AG, Hogan TP, Voruganti LNP, Heslegrave RJ. Patients' experiences on antipsychotic medications: implications for outcome and quality of life. Int Clin Psyhcopharm 1995; 10(Suppl 3): 123-132
- Brekke JS, Levin S, Wolkon GH et al. Psychosocial functioning and subjective experience in schizophrenia. Schiz Bull 1993; 19: 599-608.
- Romney DM. Psychosocial functioning and subjective experience in schizophrenia: A reanalysis. Schiz Bull 1995; 21: 405-410.
- A conceptual model of quality of life in schizophrenia: Description and preliminary clinical validation
Quality of Life Research
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