Quality of life and subjective well-being during treatment with antipsychotics in out-patients with schizophrenia

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Abstract

Objective

To assess the Quality of Life (QOL) in outpatients with schizophrenia under antipsychotics from two perspectives: a “subjective” perspective as rated by the patient and an “objective” perspective as rated by the physician.

Method

EASE (External Assessment of Quality of Life in Out-patients with Schizophrenia) is a 12-month, prospective, naturalistic study of the QOL in patients on antipsychotic treatment for schizophrenia in an out-patient setting in Germany. The study included 1462 patients who were initiated on a new antipsychotic or switched to another antipsychotic. The Subjective Well-being under Neuroleptics scale (SWN) and the Quality of Life Scale (QLS) were used to assess the QOL in these patients. The Clinical Global Impression (CGI) scale was used to assess overall symptom severity. Four cohorts were identified and evaluated: (a) patients treated with olanzapine monotherapy (N = 1007), (b) another atypical antipsychotic as monotherapy (N = 335), (c) a typical antipsychotic as monotherapy (N = 32) and (d) combination therapy with more than one antipsychotic (N = 88).

Results

QOL as assessed by both SWN and QLS improved in all treatment cohorts. SWN responses in the respective cohorts were (a) 52.3%, (b) 38.8%, (c) 31.3% and (d) 44.3%, whilst the QLS responses were (a) 58.2%, (b) 45.1%, (c) 59.4% and (c) 40.9%. Symptom severity as assessed by the CGI also improved over time regardless of the type of antipsychotic. An increase of one point on the CGI corresponded to a change in SWN total score of − 9.67 points and a change in QLS total score of − 13.36 points.

Conclusions

Both QOL and symptom severity improved over the 12-month study period, regardless of the type of antipsychotic taken. QOL improvement as perceived both from a “subjective” and an “objective” perspective was greatest in the cohort on olanzapine monotherapy.

Introduction

Schizophrenia is known to have a considerable impact on patients' Quality of Life (QOL) beyond impairing psychosocial functioning through positive and negative symptoms (Hofer et al., 2004). Whilst treatment for schizophrenia will often focus on positive and negative symptoms, improving patients' QOL has also been recognized as an important therapeutic aim (Naber et al., 2001, Karow and Naber, 2002). Treatment regimens for schizophrenia generally include antipsychotic medication, the undesired effects of which may, however, be an additional burden on patients' well-being and hence their QOL (Purdon et al., 2000, Zhang et al., 2004). Furthermore, the undesired effects of medication (e. g. dyskinesia) are likely to decrease compliance (Naber et al., 2005a), potentially protracting the course of illness and worsening the prognosis (Hofer et al., 2005). There is considerable evidence that atypical antipsychotics are superior to typical antipsychotics in preventing relapse and improving the QOL in patients with schizophrenia (Voruganti et al., 2000, Csernansky and Schuchart, 2002, Montes et al., 2003, Dossenbach et al., 2005). A number of recent studies have therefore sought to assess the QOL of patients with schizophrenia, especially comparing typical antipsychotics with atypical antipsychotics in their influence on QOL (Ritsner et al., 2004, Kilian et al., 2004, Silva de Lima et al., 2005).

Earlier QOL research has focused on the QOL from a physician's perspective using suitable questionnaires. The Quality of Life Scale (QLS) is one such questionnaire (Heinrichs et al., 1984) that has been widely used to “objectively” assess QOL in patients with schizophrenia (Tollefson et al., 1997, Tran et al., 1997, Hamilton et al., 1998, Revicki et al., 1999, Hamilton et al., 2000, Gureje et al., 2003, Whitty et al., 2004).

Recent interest in the patient's own perspective on the QOL has resulted in the development of questionnaires assessing well-being from a patient's perspective. The Subjective Well-being under Neuroleptics (SWN) scale is one such questionnaire used to “subjectively” assess the patient's QOL (Naber, 1995, Naber et al., 2001). This questionnaire has been used in a number of recent studies to assess the QOL in patients with schizophrenia (de Haan et al., 2002, Kluge et al., 2005, Naber et al., 2005b, Lambert et al., 2006).

As patient's perception and physician's perception of QOL have been found to differ (Voruganti et al., 2000), a comparison of self-rated and externally rated QOL and clinical outcome parameters is of considerable interest. The aim of this naturalistic study was to assess the QOL of patients with schizophrenia over time using the QLS and SWN scales and to compare the two perspectives.

Section snippets

Study design and procedures

This multicenter, naturalistic study (External Assessment of Quality of Life in Out-patients with Schizophrenia, EASE) was designed to investigate the QOL and subjective well-being in out-patients with schizophrenia during treatment with an antipsychotic. Psychiatrists in Germany participated in the study and included patients who received new antipsychotic treatment or were switched to another antipsychotic for schizophrenia over a period of 1 year. The study was conducted in accordance with

Patients

1538 patients were included in this study at 273 centers. Of these patients, 1462 (100%) in 271 centers were eligible (ICD-10 diagnosis of schizophrenia and initiation on a new antipsychotic or switch to another antipsychotic at baseline) and were included in the analysis. The final visit comprised 1006 patients (69%). As the treatment regimen was entirely up to the physician, patients were not randomized and the size of the various cohorts was not predefined by the protocol. Depending on the

Discussion

Although the number of patients actually observed in this study (N = 1538) exceeded the number of patients planned (N = 1500), the number of evaluable patients was slightly lower (N = 1462). The number of patients treated with olanzapine (N = 1007) exceeded the expected number considerably (N = 330–660). The proportion of patients treated with another atypical antipsychotic and with a typical antipsychotic in this study appears to reflect current patterns of use seen with the various compounds in current

Conclusions

The QOL of patients suffering from schizophrenia improved after initiation of or change to a new treatment with antipsychotics. This finding held true from two different perspectives: assessment by the physician (using the Quality of Life Scale, QLS) and self-assessment by the patient (using the Subjective Well-being under Neuroleptics, SWN scale). Improvement, both in terms of clinical effectiveness (assessed using the CGI) and QOL (assessed using the SWN and QLS), showed high correlation at

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  • Cited by (0)

    This study was supported by Lilly Deutschland GmbH, Germany.

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