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04-01-2012 | General practice | Article

Patient expectations help determine quality of life in schizophrenia

Abstract

Free abstract

MedWire News: Among patients with schizophrenia, expectations for the future have a greater impact on quality of life than do symptoms, European researchers have shown.

They say that caregivers ought to be aware of this "so as to deal with possible disappointments in patients receiving a new efficient treatment."

Bruno Falissard (INSERM Paris, France) and co-workers in France and Germany investigated the factors that influence health-related quality of life in patients with schizophrenia.

"We hypothesized that, when embarking on a new treatment, patients with schizophrenia who continue to experience significant symptoms will present a rise in their levels of expectations and perceived position in life, but their level of quality of life does not change or can even deteriorate," explain Falissard et al in the journal European Psychiatry.

"We also hypothesized that level of symptoms is negatively correlated to expectations, negatively correlated to perceived position in life and not correlated, or even positively correlated, with quality of life."

The team obtained data on 306 outpatients who had participated in a randomized controlled trial of antipsychotic therapy for schizophrenia. The mean age of patients was 41.1 years and most were considered to be moderately ill at baseline.

Patients were assessed at 0, 6, and 12 months for quality of life using the Outcome revealed by Preference in Schizophrenia Scale (OPS) and for symptoms using the Positive and Negative Syndrome Scale (PANSS).

Between 0 and 6 months, PANSS scores decreased, indicating a significant improvement in disease severity. Meanwhile, patients' levels of expectations increased significantly over time, whereas their perceived position in life and overall quality of life remained unchanged.

Correlation analysis revealed that low levels of expectation were associated with high levels of emotional distress, negative symptoms, conceptual disorganization, and overall symptoms.

In other words, the more symptomatic the patient, the lower their expectations, the authors remark.

Further analysis showed that a low perceived position in life was associated with high levels of emotional distress, positive symptoms, negative symptoms, conceptual disorganization, and overall symptoms.

Thus, the more symptomatic the patients, the lower their perceived position in life, say Falissard et al. Interestingly, however, quality of life was not significantly associated with symptoms.

"To summarize our results, when initiating a new treatment, patients with schizophrenia who continue to experience significant symptoms increase their level of expectations over time, while their perceived position in life is stable, as is their quality of life despite a slight trend toward deterioration," the researchers conclude.

"When symptoms improve, the patient's level of expectations increases, the perceived position in life improves, and quality of life is stable."

By Joanna Lyford

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