Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-17T11:25:36.518Z Has data issue: false hasContentIssue false
  • English
  • Français

Improved quality of life over one year is associated with improved adherence in patients with schizophrenia

Published online by Cambridge University Press:  15 April 2020

K.P. Hayhurst ,
R.J. Drake ,
J.A. Massie ,
G. Dunn ,
T.R.E. Barnes ,
P.B. Jones  and
S.W. Lewis
K.P. Hayhurst*
Affiliation:
Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom
R.J. Drake
Affiliation:
Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom
J.A. Massie
Affiliation:
Mental Health Unit, Laureate House, Manchester Mental Health & Social Care Trust, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom
G. Dunn
Affiliation:
Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, United Kingdom
T.R.E. Barnes
Affiliation:
Centre for Mental Health, Imperial College London, Charing Cross Campus, London, United Kingdom
P.B. Jones
Affiliation:
Department of Psychiatry & CPFT, University of Cambridge, Cambridge, United Kingdom
S.W. Lewis
Affiliation:
Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom
*
*Corresponding author. Tel.: +44(0)161 275 8365; fax: +44(0)161 275 1668. E-mail address: [email protected] (K.P. Hayhurst).
Get access

Abstract

Aim:

Quality of life (QoL) is increasingly considered an important outcome in health research. We wished to explore the determinants of change in QoL in patients with schizophrenia over the course of a one-year RCT.

Methods:

Predictors of change in observer-rated QoL (Quality of Life Scale: QLS) were assessed in 363 patients with schizophrenia during the CUtLASS clinical trial.

Results:

Change in QLS score over the course of a year correlated with change in psychotic and depressive symptoms and treatment adherence. Linear regression showed that improvement in QoL was predicted by reduction in negative and depressive symptoms and improvement in adherence rating. These three change scores together explained 38% of the variance in QLS change. Exploration of the direction of any possible causal effect, using TETRAD, indicated that improved adherence leads to improved QoL, and that change in depression also leads to QoL change. The relationship between QoL and negative symptoms suggests that greater social activity (reflected as better QoL scores) improves negative symptoms. Such a direct relationship between treatment adherence and QoL has not been reported before.

Conclusion:

Improving adherence to medication would appear to be a key approach to improving measured quality of life in people with schizophrenia.

Keywords

AdherenceDepressionQuality of lifeSchizophreniaSymptoms
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 3 , March 2014 , pp. 191 - 196
Copyright
Copyright © European Psychiatric Association 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, D, Addington, J, Schissel, BA depression rating scale for schizophrenics. Schizophr Res 1990;3:247–251.CrossRefGoogle ScholarPubMed
Awad, AG, Voruganti, LNP, Heslegrave, RJA conceptual model of quality of life in schizophrenia: description and preliminary clinical validation. Qual Life Res 1997;6:21–26.CrossRefGoogle ScholarPubMed
Barnes, TREA rating scale for drug-induced akathisia. Br J Psychiatry 1989;154:672–676.CrossRefGoogle ScholarPubMed
Barry, MM, Crosby, CQuality of life as an evaluative measure in assessing the impact of community care on people with long-term psychiatric disorders. Br J Psychiatry 1996;168:210–216.CrossRefGoogle ScholarPubMed
Bechdolf, A, Klosterkötter, J, Hambrecht, M, Knost, B, Kuntermann, C, Schiller, Set al.Determinants of subjective quality of life in post acute patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2003;253:228–235.CrossRefGoogle ScholarPubMed
Bengtsson-Tops, A, Hansson, L, Sandlund, M, Bjarnason, O, Korkeila, J, Merinder, Let al.Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: a Nordic multicentre study. Qual Life Res 2005;14:221–229.CrossRefGoogle ScholarPubMed
Bow-Thomas, CC, Velligan, DI, Miller, AL, Olsen, JPredicting quality of life from symptomatology in schizophrenia at exacerbation and stabilization. Psychiatry Res 1999;86:131–142.CrossRefGoogle ScholarPubMed
Brekke, JS, Hoe, M, Long, J, Green, MFHow neurocognition and social cognition influence functional change during community-based psychosocial rehabilitation for individuals with schizophrenia. Schizophr Bull 2007;33:1247–1256.CrossRefGoogle ScholarPubMed
Browne, S, Clarke, M, Gervin, M, Waddington, JL, Larkin, C, O’Callaghan, EDeterminants of quality of life at first presentation with schizophrenia. Br J Psychiatry 2000;176:173–176.CrossRefGoogle ScholarPubMed
Caron, J, Mercier, C, Diaz, P, Martin, ASocio-demographic and clinical predictors of quality of life in patients with schizophrenia or schizo-affective disorder. Psychiatry Res 2005;137:203–213.CrossRefGoogle ScholarPubMed
Carpiniello, B, Lai, GL, Pariante, CM, Carta, MG, Rudas, NSymptoms, standards of living and subjective quality of life: a comparative study of schizophrenic and depressed out-patients. Acta Psychiatr Scand 1997;96:235–241.CrossRefGoogle ScholarPubMed
Cramer, J, Rosenheck, R, Xu, W, Henderson, W, Thomas, J, Charney, DDetecting improvement in quality of life and symptomatology in schizophrenia. Schizophr Bull 2001;27:227–234.CrossRefGoogle Scholar
Cramer, JA, Rosenheck, R, Xu, W, Thomas, J, Henderson, W, Charney, DSQuality of life in schizophrenia: a comparison of instruments. Schizophr Bull 2000;26:659–666.CrossRefGoogle ScholarPubMed
Eack, SM, Newhill, CEPsychiatric symptoms and quality of life in schizophrenia: a meta-analysis. Schizophr Bull 2007;33:1225–1237.CrossRefGoogle ScholarPubMed
Faulkner, G, Cohn, T, Remington, G, Irving, HBody mass index, waist circumference and quality of life in individuals with schizophrenia. Schizophr Res 2007;90:174–178.CrossRefGoogle ScholarPubMed
Fitzgerald, PB, de Castella, ARA, Filia, K, Collins, J, Brewer, K, Williams, CLet al.A longitudinal study of patient- and observer-rated quality of life in schizophrenia. Psychiatry Res 2003;119:55–62.CrossRefGoogle Scholar
Fitzgerald, PB, Williams, CL, Corteling, N, Filia, SL, Brewer, K, Adams, Aet al.Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand 2001;103:387–392.CrossRefGoogle Scholar
Fujii, DE, Wylie, AM, Nathan, JHNeurocognition and long-term prediction of quality of life in outpatients with severe and persistent mental illness. Schizophr Res 2004;69:67–73.CrossRefGoogle ScholarPubMed
Galletly, CA, Clark, CR, McFarlane, AC, Weber, DLRelationships between changes in symptom ratings, neuropsychological test performance and quality of life in schizophrenic patients treated with clozapine. Psychiatry Res 1997;72:161–166.CrossRefGoogle ScholarPubMed
Górna, K, Jaracz, K, Rybakowski, F, Rybakowski, JDeterminants of objective and subjective quality of life in first-time-admission schizophrenic patients in Poland: a longitudinal study. Qual Life Res 2008;17:237–247.CrossRefGoogle ScholarPubMed
Gourevitch, R, Abbadi, S, Guelfi, JDQuality of life in schizophrenics with and without the deficit syndrome. Eur Psychiatry 2004;19:172–174.CrossRefGoogle ScholarPubMed
Green, MF, Kern, RS, Braff, DL, Mintz, JNeurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophr Bull 2000;26:119–136.CrossRefGoogle ScholarPubMed
Guy, WECDEU Assessment Manual for Psychopharmacology. Maryland, US: US Department of Health, Education and Welfare; 1976.Google Scholar
Hayward, P, Chan, N, Kemp, R, Youle, S, David, AMedication self-management: a preliminary report on an intervention to improve medication compliance. J Ment Health 1995;4:511–517.CrossRefGoogle Scholar
Heinrichs, DW, Hanlon, TE, Carpenter, WTThe Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984;10:388–398.CrossRefGoogle ScholarPubMed
Hofer, A, Kemmler, G, Eder, U, Edlinger, M, Hummer, M, Fleischhacker, WWQuality of life in schizophrenia: the impact of psychopathology, attitude toward medication and side effects. J Clin Psychiatry 2004;65:932–939.CrossRefGoogle ScholarPubMed
Hogan, TP, Awad, AG, Eastwood, RA self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983;13:177–183.CrossRefGoogle ScholarPubMed
Huppert, JD, Weiss, KA, Lim, R, Pratt, S, Smith, TEQuality of life in schizophrenia: contributions of anxiety and depression. Schizophr Res 2001;51:171–180.CrossRefGoogle ScholarPubMed
Jarema, M, Konieczyńska, ZQuality of life in schizophrenia: impact of psychopathology, patients’ gender and antipsychotic treatment. Int J Psychiatry Clin Pract 2001;5:19–26.Google Scholar
Jones, PB, Barnes, TRE, Davies, L, Dunn, G, Lloyd, H, Hayhurst, KPet al.Randomized controlled trial of the effect on quality of life of second- vs first- generation antipsychotic drugs in schizophrenia. Cost utility of the latest antipsychotic drugs in schizophrenia study (CUtLASS 1). Arch Gen Psychiatry 2006;63:1079–1087.CrossRefGoogle Scholar
Karow, A, Moritz, S, Lambert, M, Schoder, S, Krausz, MPANSS syndromes and quality of life in schizophrenia. Psychopathology 2005;38:320–326.CrossRefGoogle Scholar
Kay, SR, Fiszbein, A, Opler, LAThe Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.CrossRefGoogle Scholar
Kilian, R, Dietrich, S, Toumi, M, Angermeyer, MCQuality of life in persons with schizophrenia in out-patient treatment with first- or second-generation antipsychotics. Acta Psychiatr Scand 2004;110:108–118.CrossRefGoogle ScholarPubMed
Lambert, M, Naber, DCurrent issues in schizophrenia: overview of patient acceptability, functioning capacity and quality of life. CNS Drugs 2004;18:5–17.CrossRefGoogle ScholarPubMed
Lehman, AFMeasures of quality of life among persons with severe and persistent mental disorders. Soc Psychiatry Psychiatr Epidemiol 1996;31:78–88.CrossRefGoogle ScholarPubMed
Lewis, SW, Barnes, TRE, Davies, L, Murray, RM, Dunn, G, Hayhurst, KPet al.Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull 2006;32:715–723.CrossRefGoogle ScholarPubMed
Lewis, SW, Davies, L, Jones, PB, Barnes, TRE, Murray, RM, Kerwin, Ret al.Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment. Health Technol Assess 2006;10:17.CrossRefGoogle ScholarPubMed
Lord, FMA paradox in the interpretation of group comparisons. Psychol Bull 1967;68:304–305.CrossRefGoogle ScholarPubMed
Mahmoud, A, Hayhurst, KP, Drake, RJ, Lewis, SW, Barnes, TREThe ANNSERS (Antipsychotic Non-Neurological Side Effects Rating Scale): validation of sexual side-effect measurement. Ther Adv Psychopharmacol 2011;1:97–100.CrossRefGoogle ScholarPubMed
Naber, DA self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables. Int Clin Psychopharmacol 1995;10:133–138.Google ScholarPubMed
Narvaez, JM, Twamley, EW, McKibbin, CL, Heaton, RK, Patterson, TLSubjective and objective quality of life in schizophrenia. Schizophr Res 2008;98:201–208.CrossRefGoogle Scholar
Norman, GRIssues in the use of change scores in randomized trials. J Clin Epidemiol 1989;42:1097–1105.CrossRefGoogle ScholarPubMed
Ohlsen, RI, Williamson, R, Yusufi, B, Mullan, J, Irving, D, Mukherjee, Set al.Interrater reliability of the Antipsychotic Non-Neurological Side-Effects Rating Scale measured in patients treated with clozapine. J Psychopharmacol 2008;22:323–329.CrossRefGoogle ScholarPubMed
Olfson, M, Uttaro, T, Carson, WH, Tafesse, EMale sexual dysfunction and quality of life in schizophrenia. J Clin Psychiatry 2005;66:331–338.CrossRefGoogle Scholar
Puschner, B, Angermeyer, MC, Leese, M, Thornicroft, G, Schene, A, Kikkert, Met al.Course of adherence to medication and quality of life in people with schizophrenia. Psychiatry Res 2009;165:224–233.CrossRefGoogle ScholarPubMed
Reine, G, Lançon, C, Di Tucci, S, Sapin, C, Auquier, PDepression and subjective quality of life in chronic phase schizophrenic patients. Acta Psychiatr Scand 2003;108:297–303.CrossRefGoogle ScholarPubMed
Ruggeri, M, Nosè, M, Bonetto, C, Cristofalo, D, LaSalvia, A, Salvi, Get al.Changes and predictors of change in objective and subjective quality of life. Multiwave follow-up study in community psychiatric practice. Br J Psychiatry 2005;187:121–130.CrossRefGoogle ScholarPubMed
Simpson, GM, Angus, JWSA rating scale for extrapyramidal side effects. Acta Psychiatr Scand 1970;45:11–19.CrossRefGoogle Scholar
Spirtes, P, Glymour, CN, Scheines, RCausation, prediction and search, 2nd ed, Cambridge, MA: MIT Press; 2000.Google Scholar
Spirtes, P, Scheines, R, Meek, C, Glymour, CTETRAD II - Version 1.2 for DOS.©. Lawrence Erlbaum Associates; 1994.Google Scholar
Staring, ABP, Mulder, CL, Duivenvoorden, HJ, De Haan, L, Van der Gaag, MFewer symptoms vs. more side-effects in schizophrenia? Opposing pathways between antipsychotic medication compliance and quality of life. Schizophr Res 2009;113:27–33.CrossRefGoogle ScholarPubMed
Tas, C, Brown, E, Cubukcuoglu, Z, Aydemir, O, Danaci, AE, Brüne, MTowards an integrative approach to understanding quality of life in schizophrenia: the role of neurocognition, social cognition, and psychopathology. Compr Psychiatry 2013;54:262–268.CrossRefGoogle ScholarPubMed
Tempier, R, Pawliuk, NInfluence of novel and conventional antipsychotic medication on subjective quality of life. J Psychiatry Neurosci 2001;26:131–136.Google ScholarPubMed
Tolman, AW, Kurtz, MMNeurocognitive predictors of objective and subjective quality of life in individuals with schizophrenia: a meta-analytic investigation. Schizophr Bull 2012;38:304–315.CrossRefGoogle ScholarPubMed
Tomotake, M, Kaneda, Y, Iga, J.-I., Kinouchi, S, Tayoshi, S, Motoki, Iet al.Subjective and objective measures of quality of life have different predictors for people with schizophrenia. Psychol Rep 2006;99:477–487.CrossRefGoogle ScholarPubMed
Voruganti, L, Cortese, L, Oyewumi, L, Cernovsky, Z, Zirul, S, Awad, AComparative evaluation of conventional and novel antipsychotic drugs with reference to their subjective tolerability, side-effect profile and impact on quality of life. Schizophr Res 2000;43:135–145.CrossRefGoogle ScholarPubMed
Yusufi, BZ, Mukherjee, S, Aitchison, K, Dunn, G, Page, E, Barnes, TRInter-rater reliability of the Antipsychotic Non-Neurological Side Effects Scale (ANNSERS). Schizophr Bull 2005;31:574.Google Scholar
Submit a response

Comments

No Comments have been published for this article.