Skip to main content
SpringerLink
Log in

The Distress/Protection Vulnerability Model of Quality of Life Impairment Syndrome

  • Chapter
Book cover Quality of Life Impairment in Schizophrenia, Mood and Anxiety Disorders

Abstract

In this chapter the author describes the conceptual basis of the health related quality of life (HRQL) impairment syndrome in severe mental disorders (SMD) such as schizophrenia, schizoaffective, mood and anxiety disorders. He presents the evidence for its validity, and identifies some likely directions for future research and development. Based on the author’s and his team research contributions and complementary theoretical considerations, the author explores four issues in this chapter: the quality of life concept, interpreting HRQL findings, conceptualizing HRQL impairment in the framework of the Distress/Protection Vulnerability Model (DPV), and implications for future research. Evidence for the concept’s validity is assessed, followed by a discussion of the possible evolvement of the concept, to encompass biologic domains. Finally, there is a review of the research implications of the HRQL impairment concept and the DPV model followed by a discussion of some major areas of unresolved questions for future research

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Calman KC. Quality of life in cancer patients–an hypothesis. J Med Ethics. 1984; 10:124–127.

    PubMed  CAS  Google Scholar 

  2. Maslow, AH. (1962) Toward a Psychology of Being. Van Nostrand, New York.

    Google Scholar 

  3. Wolf JRLM. Client needs and quality of life. Psychiatric Rehabilitation Journal, 1997; 20:16–24.

    Google Scholar 

  4. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med, 1996; 334:835–840.

    Article  PubMed  CAS  Google Scholar 

  5. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA, 1995; 273: 59–65.

    Article  PubMed  CAS  Google Scholar 

  6. Smith KW, Avis NE, Assmann SF. Distinguishing between quality of life and health status in quality of life research: A meta-analysis. Quality of Life Research, 1999; 8: 447–459.

    Article  PubMed  CAS  Google Scholar 

  7. Orley J, Saxena S, Herrman H. Quality of life and mental illness. Reflections from the perspective of the WHOQOL. Br J Psychiatry, 1998; 172:291–293.

    PubMed  CAS  Google Scholar 

  8. Fitzgerald PB, Williams CL, Corteling N, et al. Subject and observer-rated quality of life in schizophrenia. Acta Psychiatrica Scandinavica, 2001; 103:387–392.

    Article  PubMed  CAS  Google Scholar 

  9. Ruggeri M, Bisoffi G, Fontecedro L, Warner R. Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach: The South Verona Outcome Project 4. British Journal of Psychiatry, 2001; 178: 268–275.

    Article  PubMed  CAS  Google Scholar 

  10. Khatri N, Romney DM, Pelletier G. Validity of self-reports about quality of life among patients with schizophrenia. Psychiatric Services, 2001; 52: 534–535.

    Article  PubMed  CAS  Google Scholar 

  11. Kaiser W, Priebe S, Barr W, Hoffmann K, Isermann M, Roder-Wanner UU, Huxley P. Profiles of subjective quality of life in schizophrenic in- and out-patient samples. Psychiatry Research, 1997; 66: 153–166.

    Article  PubMed  CAS  Google Scholar 

  12. Trauer T, Duckmanton RA, Chiu E. A study of the quality of life of the severely mentally ill. International Journal of Socical Psychiatry, 1998; 44:79–91.

    Article  CAS  Google Scholar 

  13. Lobana A, Mattoo SK, Basu D, Gupta N. Quality of life in schizophrenia in India: comparison of three approaches. Acta Psychiatrica Scandinavica, 2001; 104: 51–55.

    Article  PubMed  CAS  Google Scholar 

  14. Awad AG, Voruganti LNP, Heselgrave RJ. A Conceptual Model of Quality of Life in Schizophrenia: Description and Preliminary Clinical Validation. Quality of Life Res 1997; 6: 21–26.

    Article  CAS  Google Scholar 

  15. Zissi A, Barry MM, Cochrane R. A mediational model of quality of life for individuals with severe mental health problems. Psychological Medicine, 1998; 28: 1221–1230.

    Article  PubMed  CAS  Google Scholar 

  16. Ritsner M, Modai I, Endicott J, et al. Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients. J Clin Psychiatry 2000, 61: 880–889.

    Article  PubMed  CAS  Google Scholar 

  17. Ritsner M, Kurs R, Gibel A, Hirschmann S, Shinkarenko E, Ratner Y. Predictors of quality of life in major psychoses: a naturalistic follow-up study. Journal of Clinical Psychiatry, 2003; 64: 308–315.

    Article  PubMed  Google Scholar 

  18. Ritsner, M, Kurs, R. Quality-of-Life Impairment in Severe Mental Illness: Focus on Schizoaffective Disorders. In: Schizoaffective Disorder: New Research. Ed. William H. Murray, NOVA Publishers, New York, 2006; pp. 69–107.

    Google Scholar 

  19. Ritsner M, Ponizovsky A, Endicott J, et al. The impact of side-effects of antipsychotic agents on life satisfaction of schizophrenia patients: a naturalistic study. Eur Neuropsychopharmacol 2002; 12: 31–38.

    Article  PubMed  CAS  Google Scholar 

  20. Ritsner M, Ben-Avi I, Ponizovsky A, Timinsky I, Bistrov E, Modai I. Quality of life and coping with schizophrenia symptoms. Qual Life Res., 2003; 12: 1–9.

    Article  PubMed  CAS  Google Scholar 

  21. Ritsner M. Predicting changes in domain-specific quality of life of schizophrenia patients. J Nerv Ment Dis., 2003; 191: 287–294.

    Article  PubMed  Google Scholar 

  22. Ritsner M, Gibel A, Ratner Y. Determinants of Changes in Perceived Quality of Life in the Course of Schizophrenia. Qual Life Res. 2006; 15:515–526.

    Article  PubMed  Google Scholar 

  23. Ritsner M, Modai I, Kurs R, et al. Subjective Quality of Life Measurements in Severe Mental Health Patients: Measuring Quality of Life of Psychiatric Patients: Comparison Two Questionnaires. Quality Life Research, 2002; 11: 553–561.

    Article  CAS  Google Scholar 

  24. Ponizovsky AM, Grinshpoon A, Levav I, Ritsner MS. Life satisfaction and suicidal attempts among persons with schizophrenia. Comprehensive Psychiatry, 2003; 44: 442–447.

    Article  PubMed  Google Scholar 

  25. Ritsner, M, Farkas, H, Gibel, A. Satisfaction with quality of life varies with temperament types of patients with schizophrenia. Journal of Nervous and Mental Disease, 2003; 191: 668–674.

    Article  PubMed  Google Scholar 

  26. Kurs R, Farkas H, Ritsner M. Quality of life and temperament factors in schizophrenia: comparative study of patients, their siblings and controls. Quality of Life Research, 2005;14: 433–440.

    Article  PubMed  Google Scholar 

  27. Ritsner M, Kurs R, Ponizovsky A, Hadjez J. Perceived quality of life in schizophrenia: relationships to sleep quality. Quality of Life Research, 2004;13: 783–791.

    Article  PubMed  Google Scholar 

  28. Ritsner, M, Perelroyzen, G, Kurs, R, Ratner, Y, Jabarin, M, Gibel, A. Quality of life outcomes in schizophrenia patients treated with atypical and typical antipsychotic agents: A naturalistic comparative study. International Clinical Psychopharmacology, 2004; 24: 582–591.

    Article  CAS  Google Scholar 

  29. Diener E, Diener M. Cross-cultural correlates of life satisfaction and self-esteem. J Pers Soc Psychol., 1995; 68:653–663.

    Article  PubMed  CAS  Google Scholar 

  30. Barry MM. Well-being and life satisfaction as components of quality of life in mental disorders. In. eds. H Katsching, H Freeman, and N Sartorius, Quality of Life in Mental Disorders. Chichester: John Wiley & Sons, 1997.

    Google Scholar 

  31. Hansson L, Middelboe T, Merinder L, Bjarnason O, Bengtsson-Tops A, Nilsson L, Sandlund M, Sourander A, Sorgaard KW, Vinding H. Predictors of subjective quality of life in schizophrenic patients living in the community. A Nordic multicentre study. : International Journal of Social Psychiatry, 1999; 45: 247–258.

    PubMed  CAS  Google Scholar 

  32. Diener E, Oishi S, Lucas RE. Personality, culture, and subjective well-being: emotional and cognitive evaluations of life. Annu Rev Psychol., 2003; 54:403–425.

    Article  PubMed  Google Scholar 

  33. Eklund M, Backstrom M, Hansson L. Personality and self-variables: important determinants of subjective quality of life in schizophrenia out-patients. Acta Psychiatrica Scandinavica, 2003; 108: 134–143.

    Article  PubMed  CAS  Google Scholar 

  34. Yanos PT, Moos RH. Determinants of functioning and well-being among individuals with schizophrenia: An integrated model. Clin Psychol Rev. 2006; 27:58–77.

    Article  PubMed  Google Scholar 

  35. Ritsner M, Kurs R. Impact of antipsychotic agents and their side effects on the quality of life in schizophrenia. Expert Review and Pharmacoeconomic Outcomes Research, 2002; 2: 89–98.

    Google Scholar 

  36. Ritsner M, Kurs R. Quality of life outcomes in mental illness: schizophrenia, mood and anxiety disorders. Expert Review and Pharmacoeconomic Outcomes Research, 2003; 3: 189–199.

    Article  Google Scholar 

  37. Awad AG, Voruganti LN. New antipsychotics, compliance, quality of life, and subjective tolerability–are patients better off? Canadian Journal of Psychiatry, 2004; 49: 297–302.

    Google Scholar 

  38. Naber D, Karow A, Lambert M. Subjective well-being under the neuroleptic treatment and its relevance for compliance. Acta Psychiatrica Scandinavica Supplementum, 2005; 427: 29–34.

    Article  PubMed  Google Scholar 

  39. Hansson L. Determinants of quality of life in people with severe mental illness. Acta Psychiatr Scand Suppl., 2006; 429:46–50.

    Article  PubMed  Google Scholar 

  40. Heinrichs DW, Hanlon TE, Carpenter WT. The Quality of Life Scale: an instrument for rating the schizophrenic deficit scale. Schizophr. Bull., 1984; 10:388–398.

    PubMed  CAS  Google Scholar 

  41. Stone WS, Faraone SV, Seidman LJ, et al. Concurrent validation of schizotaxia: a pilot study. Biol Psychiatry, 2001; 50:434–440.

    Article  PubMed  CAS  Google Scholar 

  42. Tsuang MT, Stone WS, Gamma F, Faraone SV. Schizotaxia: current status and future directions. Curr Psychiatry Rep., 2003; 5:128–134.

    Article  PubMed  Google Scholar 

  43. Erickson DH, Beiser M, Iacono WG, et al. The role of social relationships in the course of first-episode schizophrenia and affective psychosis. Am J Psychiatry., 1989; 146:1456–1461.

    PubMed  CAS  Google Scholar 

  44. Bechdolf A, Pukrop R, Kohn D, et al. Subjective quality of life in subjects at risk for a first episode of psychosis: a comparison with first episode schizophrenia patients and healthy controls. Schizophr Res., 2005; 79:137–143.

    Article  PubMed  Google Scholar 

  45. Browne S, Clarke M, Gervin M, et al. Determinants of quality of life at first presentation with schizophrenia. Br J Psychiatry, 2000; 176:173–176.

    Article  PubMed  CAS  Google Scholar 

  46. Melle I, Haahr U, Friis S, et al. Reducing the duration of untreated first-episode psychosis – effects on baseline social functioning and quality of life. Acta Psychiatr Scand., 2005; 112:469–473.

    Article  PubMed  CAS  Google Scholar 

  47. Czernikiewicz A, Gorecka J, Kozak-Sykala A. [Premorbid adjustment and quality of life in schizophrenia]. Pol Merkuriusz Lek., 2005; 19:659–662.

    Google Scholar 

  48. Malla A, Payne J. First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull., 2005; 31:650–671.

    Article  PubMed  Google Scholar 

  49. Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 2005; 162:1171–1178.

    Article  PubMed  Google Scholar 

  50. Priebe S, Roeder-Wanner UU, Kaiser W. Quality of life in first-admitted schizophrenia patients: a follow-up study. Psychological Medicine, 2000; 30: 225–230.

    Article  PubMed  CAS  Google Scholar 

  51. Henkel H, Schmitz M, Berghofer G. [Quality of life of the mentally ill] Wiener medizinische Wochenschrift, 2000; 150:32–36.

    PubMed  CAS  Google Scholar 

  52. Huppert JD, Smith TE. Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor. Journal of Nervous and Mental Disease, 2001; 189:669–675.

    Article  PubMed  CAS  Google Scholar 

  53. Tempier R, Mercier C, Leouffre P, Caron J. Quality of life and social integration of severely mentally ill patients: a longitudinal study. Journal of Psychiatry and Neuroscience, 1997; 22: 249–255.

    PubMed  CAS  Google Scholar 

  54. Skantze K. Subjective quality of life and standard of living: a 10-year follow-up of out-patients with schizophrenia. Acta Psychiatrica Scandinavica, 1998; 98:390–399.

    PubMed  CAS  Google Scholar 

  55. Kentros MK, Terkelsen K, Hull J, et al. The relationship between personality and quality of life in persons with schizoaffective disorder and schizophrenia. Quality of Life Research, 1997; 6:118–122.

    Article  PubMed  CAS  Google Scholar 

  56. Hansson L, Eklund M, Bengtsson-Tops A. The relationship of personality dimensions as measured by the temperament and character inventory and quality of life in individuals with schizophrenia or schizoaffective disorder living in the community. Quality of Life Research, 2001;10:133–139.

    Article  PubMed  CAS  Google Scholar 

  57. Eklund M, Backstrom M. A model of subjective quality of life for outpatients with schizophrenia and other psychoses. Quality of Life Research, 2005; 14: 1157–1168.

    Article  PubMed  Google Scholar 

  58. Zubin, J., Spring, S. Vulnerability - a new model of schizophrenia. Journal of Abnormal Psychology, 1977; 88:103–128.

    Article  Google Scholar 

  59. Green MF, Nuechterlein KH. Backward masking performance as an indicator of vulnerability to schizophrenia. Acta Psychiatr Scand Suppl., 1999; 395:34–40.

    PubMed  CAS  Google Scholar 

  60. Berner P. Conceptualization of vulnerability models for schizophrenia: historical aspects. Am J Med Genet., 2002;114:938–942.

    Article  PubMed  Google Scholar 

  61. Szoke, A., Schurhoff, F., Ferhadian, N., et al. Temperament in schizophrenia: a study of the tridimensional personality questionnaire (TPQ). European Psychiatry, 2002; 17: 379–383.

    Article  PubMed  Google Scholar 

  62. Ormel J, Oldehinkel AJ, Vollebergh W. Vulnerability before, during, and after a major depressive episode: a 3-wave population-based study. Arch Gen Psychiatry, 2004; 61:990–996.

    Article  PubMed  Google Scholar 

  63. Ritsner, M, Susser, E. Temperament types are associated with weak self-construct, elevated distress, and emotion-oriented coping in schizophrenia: evidence for a complex vulnerability marker? Psychiatry Research, 2004; 128:219–228.

    Article  PubMed  Google Scholar 

  64. Jansen LM, Gispen-de Wied CC, Kahn RS. Selective impairments in the stress response in schizophrenic patients. Psychopharmacology (Berl)., 2000; 149:319–325.

    Article  CAS  Google Scholar 

  65. Myin-Germeys, I, Jim van, OS, Schwartz, JE, Stone, AA, Delespaul, PA. Emotional reactivity to daily life stress in psychosis. Archives of General Psychiatry, 2001; 58:1093–1208.

    Article  Google Scholar 

  66. Walker EF, Diforio D. Schizophrenia: a neural diathesis-stress model. Psychological Reviews, 1997; 104: 667–685.

    Article  CAS  Google Scholar 

  67. Majewska, MD. Neurosteroids: endogenous bimodal modulators of the GABAa receptor. Mechanisms of action and physiological significance. Prog. Neurobiol., 1992; 38: 379–395.

    CAS  Google Scholar 

  68. Debonnel G, Bergeron R, de Montigny C. Potentiation by dehydroepiandrosterone of the neuronal response to N-methyl-D-aspartate in the CA3 region of the rat dorsal hippocampus: an effect mediated via sigma receptors. J Endocrinol, 1996;150 (Suppl):33–42.

    Google Scholar 

  69. Rupprecht R. The neuropsychopharmacological potential of neuroactive steroids. J Psychiatr Res, 1997;31:297–314.

    Article  PubMed  CAS  Google Scholar 

  70. Wen S, Dong K, Onolfo JP, et al., Treatment with dehydroepiandrosterone sulfate increases NMDA receptors in hippocampus and cortex. Eur J Pharmacol 2001; 430:373–374.

    Article  PubMed  CAS  Google Scholar 

  71. Migues, PV, Johnston, AN, Rose, SP. Dehydroepiandosterone and its sulphate enhance memory retention in day-old chicks. Neuroscience, 2002; 109: 243–251.

    Article  PubMed  CAS  Google Scholar 

  72. Wolf OT, Kirschbaum C. Actions of dehydroepiandrosterone and its sulfate in the central nervous system: effects on cognition and emotion in animals and humans. Brain Res Brain Res Rev 1999; 30:264–288

    Article  PubMed  CAS  Google Scholar 

  73. Hu Y, Cardounel A, Gursoy E, et al., Anti-stress effects of dehydroepiandrosterone: protection of rats against repeated immobilization stress-induced weight loss, glucocorticoid receptor production, and lipid peroxidation. Biochem Pharmacol., 2000; 59:753–62

    Article  PubMed  CAS  Google Scholar 

  74. Boudarene, M, Legros, JJ. Study of the stress response: role of anxiety, cortisol and DHEA-S. Encephale, 2002; 28:139–146.

    PubMed  CAS  Google Scholar 

  75. Lapchak, PA, Araujo, DM. Preclinical development of neurosteroids as neuroprotective agents for the treatment of neurodegenerative diseases. Int. Rev. Neurobiol., 2001; 46:379–397.

    Article  PubMed  CAS  Google Scholar 

  76. Ritsner M, Maayan R, Gibel A, et al. Elevation of the cortisol/dehydroepiandrosterone ratio in schizophrenia patients. European Neuropsychopharmacology, 2004; 14: 267–273.

    Article  PubMed  CAS  Google Scholar 

  77. Ritsner M, Gibel A, Ram E, et al. Alterations in DHEA metabolism in schizophrenia: two-month case-control study. Eur Neuropsychopharmacol., 2006;16:137–146.

    Article  PubMed  CAS  Google Scholar 

  78. Johnson, MD, Bebb, RA, Sirrs, SM. Uses of DHEA in aging and other disease states. Ageing Res. Rev. , 2002; 1: 29–41.

    Article  PubMed  CAS  Google Scholar 

  79. Ritsner, MS, Gibel, A, Ratner, Y, et al. Improvement of sustained attention, visual and movement skills, but not clinical symptomatology, following dehydroepiandrosterone augmentation in schizophrenia: a randomized double-blind, placebo-controlled, crossover trial. Journal of Clinical Psychopharmacology 2006; 26:495–499.

    Article  PubMed  CAS  Google Scholar 

  80. Griebel G, Stemmelin J, Gal CS, Soubrie P. Non-peptide vasopressin V1b receptor antagonists as potential drugs for the treatment of stress-related disorders. Curr Pharm Des, 2005; 11:1549–1559.

    Article  PubMed  CAS  Google Scholar 

  81. Insel TR, Young LJ. The neurobiology of attachment. Nat Rev Neurosci, 2001; 2:129–136.

    Article  PubMed  CAS  Google Scholar 

  82. Phillips ML, Drevets WC, Rauch SL, Lane R. Neurobiology of emotion perception I: The neural basis of normal emotion perception. Biol Psychiatry, 2003; 54:504–514.

    Article  PubMed  Google Scholar 

  83. Wang J, Rao H, Wetmore GS, Perfusion functional MRI reveals cerebral blood flow pattern under psychological stress. Proc Natl Acad Sci U S A, 2005; 102:17804–17809.

    Article  PubMed  CAS  Google Scholar 

  84. Taylor SF, Phan KL, Britton JC, Liberzon I. Neural response to emotional salience in schizophrenia. Neuropsychopharmacology, 2005; 30:984–995.

    Article  PubMed  Google Scholar 

  85. Davidson RJ. Well-being and affective style: neural substrates and biobehavioural correlates. Philos Trans R Soc Lond B Biol Sci., 2004; 359:1395–1411.

    Article  PubMed  Google Scholar 

  86. Sala M, Perez J, Soloff P, et al. Stress and hippocampal abnormalities in psychiatric disorders. Eur Neuropsychopharmacol., 2004; 14:393–405.

    Article  PubMed  CAS  Google Scholar 

  87. Herman JP, Ostrander MM, Mueller NK, Figueiredo H. Contributions of the amygdala to emotion processing: from animal models to human behavior. Neuron, 2005; 48:175–187.

    Article  CAS  Google Scholar 

  88. Phelps EA, LeDoux JE. Dopaminergic contribution to the regulation of emotional perception. Clin Neuropharmacol., 2005; 28:228–237.

    Article  Google Scholar 

  89. Schneider F, Weiss U, Kessler C, et al. Differential amygdala activation in schizophrenia during sadness. Schizophr Res., 1998; 34:133–142.

    Article  PubMed  CAS  Google Scholar 

  90. Rauch SL, Shin LM, Wright CI. Neuroimaging studies of amygdala function in anxiety disorders. Ann N Y Acad Sci., 2003; 985:389–410.

    Article  PubMed  Google Scholar 

  91. Shayegan DK, Stahl SM. Emotion processing, the amygdala, and outcome in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry, 2005; 29:840–845.

    Article  PubMed  Google Scholar 

  92. van Rijn S, Aleman A, Swaab H, Kahn RS. Neurobiology of emotion and high risk for schizophrenia: role of the amygdala and the X-chromosome. Neurosci Biobehav Rev., 2005; 29:385–397.

    Article  PubMed  CAS  Google Scholar 

  93. Whittle S, Allen NB, Lubman DI, Yucel M. The neurobiological basis of temperament: Towards a better understanding of psychopathology. Neurosci Biobehav Rev., 2005; Nov 8; [Epub ahead of print]

    Google Scholar 

  94. Wright CI, Williams D, Feczko E, Neuroanatomical Correlates of Extraversion and Neuroticism. Cereb Cortex, 2006; 16:1809–1819.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology and Acute Department, Sha’ar Menashe Mental Health Center, Israel

    Michael S. Ritsner

Authors
  1. Michael S. Ritsner
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Associate Professor, Department of Psychiatry, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa

    Michael S. Ritsner

  2. Director, Acute Department, Sha’ar Menashe, Mental Health Center, Israel

    Michael S. Ritsner

  3. Associate Editor, Quality of Life Research, Amsterdam, The Netherlands

    Michael S. Ritsner

  4. Professor Emeritus, Department of Psychiatry, Institute of Medical Science University of Toronto Chief of Psychiatry, Humber River Regional Hospital, Toronto

    A. George Awad

  5. Ontario President, The International Society of CNS, Clinical Trials and Methodology, Canada

    A. George Awad

Rights and permissions

Reprints and permissions

Copyright information

© 2007 springer

About this chapter

Cite this chapter

Ritsner, M.S. (2007). The Distress/Protection Vulnerability Model of Quality of Life Impairment Syndrome. 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_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4020-5779-3_1

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-1-4020-5777-9

  • Online ISBN: 978-1-4020-5779-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation