Symptom improvement may not increase quality of life in schizophrenia
medwireNews: Symptom improvements in patients with schizophrenia may not always lead to an increase in quality of life as measured relative to patient expectations, research shows.
A study of 306 outpatients with schizophrenia undergoing a change in antipsychotic medication found that quality of life remained stable over the study period, despite a decrease in symptoms.
Bruno Falissard (INSERM, Paris, France) and colleagues interviewed participants about their quality of life at the time of antipsychotic medication change (baseline), and 6 and 12 months later. They used the Outcome revealed by Preference in Schizophrenia instrument, which measures the difference between levels of patient expectation and perceived position in life.
Symptoms were measured at baseline and at 1, 2, 4, 6, 8, 10, and 12 months after the antipsychotic change using the Positive and Negative Syndrome Scale (PANSS).
PANSS scores decreased significantly over the year, indicating an improvement in patient symptoms with the new antipsychotic. However, levels of patient expectation significantly increased over time, even as perceived position in life remained unchanged. Quality of life also remained unchanged, with a nonsignificant trend towards a decrease.
Furthermore, symptom decrease was associated with an increase in both patient expectations and perceived position in life, but not with an increase in quality of life.
Writing in European Psychiatry, the researchers conclude that "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. When symptoms improve, the patient's level of expectations increases, the perceived position in life improves and quality of life is stable."
The authors put forward several theories for why a decrease in symptoms could be associated with an increase in patient expectations. For example, negative symptoms have been negatively correlated with insight, such that a decrease in negative symptoms may lead to an increase in insight and a consequent increase in patient expectations.
In terms of clinical practice, they suggest that "including the disappointments arising from confrontations with reality in therapeutic strategies could help patients with schizophrenia to cope with the increase in their levels of expectations."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Afsaneh Gray, medwireNews Reporter