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Antipsychotic Medications, Schizophrenia and the Issue of Quality of Life

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Quality of Life Impairment in Schizophrenia, Mood and Anxiety Disorders

Abstract

Schizophrenia as a long term disabling illness generally runs a chronic course with acute psychotic relapses that frequently requires hospitalizations. Antipsychotic medications have emerged as the cornerstone in treatment of the disorder in addition to other important interventions such as rehabilitation, psychosocial and economic support. Unfortunately antipsychotic medications has presented a number of significant limitations in terms of inconveniencing or serious side effects as well as there inability to improve certain symptoms at different stages of the illness. 30{%} to 50{%} of patients on antipsychotic medications develop serious dislike to medication as a result of becoming dysphoric, a situation that lead to compromised adherence to medications and subsequent relapse and compromised quality of~life. ∈dent Reviewing published studies involving both new and old antipsychotic medications reveal a good deal of methodological limitations that make it difficult to reach any definitive conclusion about the impact of antipsychotic medications on quality of life. However, the weight of the evidence so far can only suggest a trend favouring the new antipsychotics in terms of their positive impact on quality of life. On the other hand it is clear that medications by themselves can not directly improve quality of life but certainly can improve the potential for patients to benefit from other important interventions such as rehabilitation and psychosocial support that can have direct impact on quality of life. A number of methodological and conceptual issues are proposed to improve the quality of quality of life studies. Finally, though quality of life by itself is an important outcome it is time for the field to look beyond quality of life measurements. In addition to being an outcome, quality of life improvement can be also construed as mediator of other important outcomes such as decreased relapse rate, re-hospitalization and medical resources utilization. Similarly, improvement in quality of life can enhance strategies for improving adherence to medications and other therapeutic regimens as well as better and longer tenure in the community

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References

  1. Davies L.M., Drummond M.F. The Economic Burden of Schizophrenia. Psychiat. Bull 1990; 14: 522–555.

    Article  Google Scholar 

  2. Awad A.G., Voruganti L.N.P., Heselgrave R.J. The Aim of Antipsychotic Medications: What Are They and Are They being Achieved? CNS Drugs 1995; 4: 8–16.

    Google Scholar 

  3. Arana G.W. An Overview of Side Effects Caused by Typical Antipsychotics. J. Clin Psychiatry; 2000; 61 (Suppl 8): 5–11.

    PubMed  CAS  Google Scholar 

  4. Awad A.G. Antipsychotic Medications: Compliance and Attitudes Towards Treatment. Curr. Opin. Psychiatry. 2004; 17: 75–80.

    Article  Google Scholar 

  5. Awad A.G., Masty V., McDonnell D. The Link Between Drug Attitudes, Compliance Behaviour and Resource Use Among Individual with Schizophrenia. Poster Presented at the 150 2nd American Psychiatric Association Meeting 1999; (Washington, D.C.).

    Google Scholar 

  6. Kerwin R.W., Taylor D. New Antipsychotics: A Review of their Current Status and Clinical Practice. CNS Drugs 1996; 6: 71–82.

    CAS  Google Scholar 

  7. Awad A.G., Voruganti L.N.P. New Antipsychotics, Compliance, Quality of Life, and Subjective Tolerability – Are Patients Better Off? Can J Psychiatry 2004; 49: 297–302.

    PubMed  Google Scholar 

  8. Lieberman J., Stroup T.S., McEvoy J.P., Swartz M.S., Rosenheck R.A., Perkins D.O., Keefe, R., Davis C., Severe J., Hsiao J., and the Catie Investigators. Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. The New England J. MED; 353: 1209–1223.

    Google Scholar 

  9. Voruganti L.N.P., Cortese L., Owyeumi L., Kotteda V., Cernovsky Z., Zirul S., Awad A.G. Switching from Conventional to Novel Antipsychotic Drugs: Results of a Prospective Naturalistic Study. Schizophr. Res 2002; 57: 201–208.

    Article  PubMed  CAS  Google Scholar 

  10. Wirshing D.A., Spellberg P.J., Erhart S.M., Marder S.R., Wirshing W.C. Novel Antipsychotic and New Onset Diabetes. Biol. Psychiatry 1998; 44: 778–783.

    Article  PubMed  CAS  Google Scholar 

  11. Newcomer J.W. Second Generation (atypical) Antipsychotic and Metabolic Effects: A Comprehensive literature Review. CNS Drugs 2005; 19: 1–93.

    Article  PubMed  CAS  Google Scholar 

  12. De Nayer, DeHert M., Scheem A., Van Gaal L., Peuskins J., Conference Report: Belgain Consensus on Metabolic Problems Associated with Second Generation Antipsychotics. Int J. Psychiatry Clin Pract. 2005; 9: 130–137.

    Article  Google Scholar 

  13. Rothbard A., Murrin M.R., Jordon N., Kuno E., McFarland B., Stroup T.S., Morrissey J.P., Stiles P., Boothroyd R., Merwin E., Shern D. Effects of Antipsychotic Medication on Psychiatric Service Utilization and Cost. J Ment Health Policy Econ 2005; 8 : 83–93.

    Google Scholar 

  14. Awad A.G. Voruganti L.N.P., Heselgrave R.J., Preliminary Validation of a Conceptual Model to Assess Quality of Life in Schizophrenia. Quality of Life Res, 1997; 6: 21–26.

    Article  CAS  Google Scholar 

  15. Lambert M., Naber D. Current Issues in Schizophrenia: Overview of Patient Acceptability, Functioning Capacity and Quality of Life. CNS Drugs 2004; 18: 5–17.

    Article  PubMed  Google Scholar 

  16. Norman R.M., Malla A.K., McLean T., The Relationship of Symptoms and Level of Functioning in Schizophrenia to General Wellbeing and the Quality of Life Scale. Acta Psychiatr Scand 2000, 102: 303–309.

    Article  PubMed  CAS  Google Scholar 

  17. Barowne S, Clarke M, Gervin M., Waddington J.L., Larkin C., O’Callaghan B., Determinants of Quality of Life at First Presentation with Schizophrenia. Br. J. Psychiatry 2000; 176: 173–176.

    Article  Google Scholar 

  18. Karow A., Naber D., Subjective Wellbeing and Quality of Life under Atypical Antipsychotic Treatment. Psychopharmacology 2002; 162: 3–10.

    Article  PubMed  CAS  Google Scholar 

  19. Ritsner M., Kurs R., Impact of Antipsychotic agents and their Side Effects on the Quality of Life in Schizophrenia. Expert Rev. Pharmacoeconomics Outcomes. Res. 2002; 2: 89–98.

    Article  Google Scholar 

  20. Awad A.G., Antipsychotic Medications in Schizophrenia: How Satisfied are our Patients? In Hellewell J. Editor: Clear Perspectives 1999, 2: 1–6. London, Shire Hall International.

    Google Scholar 

  21. Voruganti L.N.P., Heselgrave R.J., Awad A.G., Seeman M., Quality of Life Measurement in Schizophrenia: Reconciling the question for subjectivity with the question of Reliability.

    Google Scholar 

  22. Kilian R., Angermeyer M.C., The Effect of Antipsychotic Treatment on Quality of Life of Schizophrenic patients under naturalistic Treatment conditions: An application of random effect regression models and propensity scores in an observational prospective trail. Quality of Life Res 2005; 14: 1275–1289.

    Article  Google Scholar 

  23. Awad A.G., Lapierre Y.D., Augus C., Rylander A., Quality of Life and Response of Negative Symptoms in Schizophrenia to Haloperidol and the Atypical Antipsychotic Remoxipride J. Psychiatry Neurosci. 1997; 22: 244–248.

    CAS  Google Scholar 

  24. Ritsner M, Kurs R., Gibel A., Hirshchmann S., Shinkarenko E., Ratner Y., Predictors of Quality of Life in Major Psychosis: A Naturalistic Follow up Study. J. Clin Psychiatry 2003; 64: 308–315.

    Article  PubMed  Google Scholar 

  25. Ritsner M., Ben-Avi I., Ponizovsky A., Timinsky I Bistrov E., Modai I., Quality of Life and Coping with Schizophrenic Symptoms. Quality Life Res. 2003; 12: 1–9.

    Article  CAS  Google Scholar 

  26. Awad A.G., Voruganti L.N.P., Impact of Atypical Antipsychotics on Quality of Life in Patients with Schizophrenia. CNS Drugs 2004; 18: 877–893.

    Article  PubMed  CAS  Google Scholar 

  27. Corrigan P.W., Reinke R., Landsberger S.A., Charate A., Toombs G.A. The Effect of Atypical Antipsychotic Medications on Psychosocial Outcome Schizophr Res 2003; 63: 91–101.

    Google Scholar 

  28. Awad A.G. Voruganti L.N.P., Heselgrave R.J., Measuring Quality of Life in Patients with Schizophrenia. Pharmacoeconomics 1997; 11: 32–47.

    PubMed  CAS  Google Scholar 

  29. Jeste D.V., Klausner M, Brecher M., Clyde C., Jone R. Clinical Evaluation of Risperidone in the Treatment of Schizophrenia: A 10 week Open Label Muticentre Trial. Psychopharmacology 1997; 131: 239–247.

    Article  PubMed  CAS  Google Scholar 

  30. Barcia D., Ayuso J.L, herraiz M.L. Calidad de vida en Pacientes Esquizofrenicos Tratados con Risperidona. An Psiquiatr 1996; 12: 403–412.

    Google Scholar 

  31. Voruganti L.N.P., Cortese L., Oyewumi L.K., Cernovsky Z., Zirul S., Awad A.G. Comparative Evaluation of Conventional and New Antipsychotic Drugs with reference to their subjective Tolerability, Side Effect, Profile and Impact on Quality of Life. Schizophr. Res. 2000; 43: 135–145.

    Article  PubMed  CAS  Google Scholar 

  32. Bobes J., Gutierrez M., Gibert J. et al. Quality of Life in Schizophrenia: Long Term Follow-up in 362 Chronic Spanish Schizophrenic Outpatients undergoing Risperidone Maintenance Treatment. Eur Psychiatry 1998; 13: 158–163.

    Article  CAS  PubMed  Google Scholar 

  33. Franz M., Lis S., Pluddemann K., et al. Conventional vs. Atypical Neuroleptic: Subjective Quality of Life in Schizophrenia Patients. Br J Psychiatry 1997; 170: 422–425.

    PubMed  CAS  Google Scholar 

  34. Hamilton S.H., Revicki D.A., Edgell E.T., et al. Clinical and Economic Outcomes of Olanzapine compared with Haloperidol for Schizophrenia: Results from a Randomized Clinical Trial. Pharmacoeconomics 1999; 15: 469–480.

    Article  PubMed  CAS  Google Scholar 

  35. Revicki D.A., Ginduso L.A., Hamilton S.H., et al. Olanzapine vs. Haloperidol in the Treatment of Schizophrenia and Other Psychotic Disorders: Quality of Life and Clinical Outcomes of a Randomized Clinical Trial. Qual Life Res 1999; 8: 417–426.

    Article  PubMed  CAS  Google Scholar 

  36. Tran P.V., Hamilton S.H., Kunz A.J., et al. Double-Blind Comparison of Olanzapine vs. Risperidone in the Treatment of Schizophrenia and Other Psychotic Disorders. J Clin Psychopharmacology 1997; 17: 407–418.

    Article  CAS  Google Scholar 

  37. Ho B.C., Miller D., Nopoulos P., et al. A Comparative Effectiveness Study of Risperidone and Olanzapine in the Treatment of Schizophrenia. J Clin Psychiatry 1999; 60: 658–663.

    Article  PubMed  CAS  Google Scholar 

  38. Naber D., Moritz S., Lambert M., et al. Improvement of Schizophrenic Patients’ Subjective well-being under Atypical Antipsychotic Drugs. Schizophr Res 2001; 50: 79–88.

    Article  PubMed  CAS  Google Scholar 

  39. Tempier R., Pawliuk N. Influence of Novel and Conventional Antipsychotic Medication on Subjective Quality of Life. J Psychiatry Neuroscience 2001; 26: 131–136.

    CAS  Google Scholar 

  40. Strakowksi S., Johnson J., DeBello M., Hamer R., Green A., Tohen M., Lieberman J., Glick I., Patel J., Quality of Life during Treatment with Haloperidol or Olanzapine in the year following a first psychotic Episode. Schizophr Res 2005; 78: 161–169.

    Article  Google Scholar 

  41. Awad A.G. First Episode Psychosis: Olanzapine and Haloperidol provide similar improvement in Quality of Life and Social Functioning; Commentary Evidence-Based Mental Health 2006; 9:47.

    Google Scholar 

  42. Meltzer H.Y., Burnett S., Bastani B., et al. Effects of Six months of -Clozapine Treatment on the Quality of Life of Chronic Schizophrenic Patients. Hosp Community Psychiatry 1990; 41: 892–897.

    PubMed  CAS  Google Scholar 

  43. Meltzer H.Y., Okayli G., Reduction of Suicidality during Clozapine Treatment of Neuroleptic-resistant Schizophrenia: Impact on Risk Benefit Assessment. Am J Psychiatry 1995; 152: 183–190.

    PubMed  CAS  Google Scholar 

  44. Naber D. A self-rating to Measure Subjective Effects of Neuroleptic Drugs, Relationships to Objective Psychopathology, Quality of Life, Compliance and other Clinical Variables. Int Clin Psychopharmacology 1995; 10 Suppl. 3: 133–138.

    Article  Google Scholar 

  45. Rosenheck R., Cramer J., Xu W., et al. A Comparison of Clozapine and Haloperidol in Hospitalized Patients with Refractory Schizophrenia. N Engl J Med 1997; 337: 809–815.

    Article  PubMed  CAS  Google Scholar 

  46. Bellack A.S., Schooler N.R., Marder S.R., Kane J.M., Brown C.H., Young Y. Do Clozapine and Risperidone Affect Social Competence and Problem Solving? Am J Psychiatry 2004; 16: 364–367.

    Article  Google Scholar 

  47. Essock S.M., Hargreaves W.A., Covell N.H. et al. Clozapine’s Effectiveness for Patients in State Hospitals: Results from a Randomized Trial. Psychopharmacology Bull 1996; 32: 683–697.

    CAS  Google Scholar 

  48. Hellewell J.S. Kalai A.H., Langham S.J. et al. Patient Satisfaction and Acceptability of Long-Term Treatment with Quetiapine. Int J Psychiatry Clin Pract 1999; 3: 105–113.

    CAS  Google Scholar 

  49. Addington D.E., Jons B., Bloom D. Reduction of Hospital Days in Chronic Schizophrenic Patients treated with Risperidone: A Retrospective Study. Clin Ther 1993; 15: 917–926.

    PubMed  CAS  Google Scholar 

  50. Albright P.S., Livingston S., Keegan D.L. Reduction of Health Care Resource Utilization and Cost following the use of Risperidone for patient with Schizophrenia previously treated with Standard Antipsychotic Therapy: A Retrospective Analysis using the Saskatchewan Health Linkage database. Clin Drug Invest 1996; 11: 289–299.

    Google Scholar 

  51. Reid W.H., Mason M., Toprac M. Saving in hospital bed days related to treatment with Clozapine. Hosp. Community Psychiatry 1994; 45: 261–263.

    PubMed  CAS  Google Scholar 

  52. Dickson R.A. Hospital Days in Clozapine Treated Patients. Can J. Psychiatry 1998; 43: 945–948.

    PubMed  CAS  Google Scholar 

  53. Awad A.G., Voruganti L.N.P. Cost-Utility Analysis in Schizophrenia. J. Clin Psychiatry 1999; 60 suppl. 3: 22–26.

    Google Scholar 

  54. Voruganti L.N.P., Awad A.G., Oyewumi L.K. Assessing Health Utilities in Schizophrenia: A feasibility Study. Pharmacoeconomics 2000; 17: 273–286.

    Article  PubMed  CAS  Google Scholar 

  55. Dernovsek M.Z., Prevolnik-Rupel V., Tavcar R. Cost Utility Analysis Research and Practical Applications (Chapter ____).

    Google Scholar 

  56. Hargreaves W.A., Shumway M. Pharmacoeconomics of Antipsychotic Drug Therapy. J. Clin Psychiatry 1996; 57: suppl. 9: 66–76.

    Google Scholar 

  57. Revicki D. Pharmacoeconomic Studies of Atypical Antipsychotic Drugs for the Treatment of Schizophrenia. Schizophr. Res 1999; 35: 101–109.

    Article  Google Scholar 

  58. Zito J.M. Pharmacoeconomics of the New Antipsychotics for the Treatment of Schizophrenia. Psychiatric Clin. North A.M. 1998; 21: 181–202.

    Article  CAS  Google Scholar 

  59. Green M.F., What are the Functional Consequences of Neurocognitive Deficits in Schizophrenia? Am J Psychiatry 1996; 153: 321–330.

    PubMed  CAS  Google Scholar 

  60. Keefe R., Poe M., Waker T., Kang J., Harvey P.H. The Schizophrenia Cognition Rating Scale: An interview based Assessment and its Relationship to Cognition, real-work functioning and functional capacity. Am J Psychiatry 2006; 163: 426–432.

    Article  PubMed  Google Scholar 

  61. Velligan D.I., Mahurin R.K., Diamond P.L., Hazelton B.C., Eckert S.L., Miller A.L. The Functional Significance of Symptomatology and Cognitive Function in Schizophrenia. Schizophr Res 1997; 25: 21–31.

    Article  PubMed  CAS  Google Scholar 

  62. Heselgrave R.J., Awad A.G. Voruganti L.N.P., The Influence of Neurocognitive deficits and symptoms on Quality of Life in Schizophrenia. J. Psychiatry Neuroscience 1997; 22: 235–243.

    Google Scholar 

  63. Moritz s., Ferahli S., Naber D. Memory and Attention Performance in Psychiatric patients: Lack of correspondence between Clinician-rated and patient-rated functioning with neuropsychological test results. J. Int Neuropsychol Soc. 2004; 10: 623–633.

    Article  PubMed  Google Scholar 

  64. Bowie C., Reichenberg A., Patterson T., Heaton R., Harvey P. Determinants of Real-World Functional Performance in Schizophrenia Subjects: Correlations with Cognition, Functional Capacity and Symptoms. Am J Psychiatry 2006; 163: 418–425.

    Article  PubMed  Google Scholar 

  65. Hooker C., Park S. Emotion processing and its relationship to Social Functioning in Schizophrenic Patients. Psychiatry Res 2002; 112: 41–50.

    Article  PubMed  Google Scholar 

  66. Wise R.A. Addictive Drugs and Brain Stimulation Reward. Ann Rev Neurosci. 1996; 19: 319–340.

    Article  PubMed  CAS  Google Scholar 

  67. Fibiger H.C. Neurobiology of Depression – focus on Dopamine. Adv Biochem Psychopharmacology 1995; 49: 1–7.

    Article  CAS  Google Scholar 

  68. Voruganti L.N.P., Slomka P., Zabel P., Costa G., So A., Mattar A., Awad A.G. Subjective Effects of AMPT induced Dopamine Depletion in Schizophrenia. The Correlation between D2 binding ration and Dysphoric Responses. Neuropsychopharmacology 2001; 25: 642–650.

    Article  PubMed  CAS  Google Scholar 

  69. de Hann L, Lavalaye J., Linszen D., Dingemans P.M.A.J., Booij J. Subjective Experiences and Striatal Dopamine D2 Receptor Occupancy in Patients with Schizophrenia stabilized by Olanzapine or Risperidol. Am J Psychiatry 2000; 157: 1019–1020.

    Article  Google Scholar 

  70. Voruganti L.N.P., Awad A.G. Subjective and Behavioural Consequences of Striatal Dopamine Depletion in Schizophrenia-findings from an in VIVO SPECTS study. Schiz Res (in press)

    Google Scholar 

  71. Voruganti L.N.P., Awad A.G. Role of Dopamine in Pleasure, Reward and Subjective responses as Important aspects of Quality of Life.

    Google Scholar 

  72. Gill T.M., Feinstein A.R. A Critical Appraisal of the Quality of Quality of Life Measurements. JAMA 1994; 272: 619–626.

    Article  PubMed  CAS  Google Scholar 

  73. Awad A.G. Voruganti L.N.P. Intervention Research in Psychosis: Issues related to the Assessment of Quality of Life. Schizophr Bull 2000; 26: 557–564.

    PubMed  CAS  Google Scholar 

  74. Awad A.G., Voruganti L.N.P. The Subjective/objective dichotomy in Schizophrenia: Relevance to nosology, research and management. In: Gaebel W., editor. Zukunftsperspktiven in Psychiatries Und Psychotherapie. Darmstadt: Steinkopff Verlag, 2002: 21–27.

    Google Scholar 

  75. Skantze K., Malm U., Dencker S.J., May P.R.A., Corrigan P. Comparison of Quality of life with standard of living in Schizophrenic Out-patients. Br J. Psychiatry 1992; 161: 797–801.

    Article  PubMed  CAS  Google Scholar 

  76. Skantze K. Subjective Quality of Life and Standard of living: A 10-year Follow up of Out-patients with Schizophrenia. Acta Psychiatr Scand. 1998; 98: 390–399.

    PubMed  CAS  Google Scholar 

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Awad, A.G., Voruganti, L.N. (2007). Antipsychotic Medications, Schizophrenia and the Issue of Quality of Life. In: Ritsner, M.S., Awad, A.G. (eds) Quality of Life Impairment in Schizophrenia, Mood and Anxiety Disorders. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-5779-3_16

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