Quality of life in bipolar type I disorder and schizophrenia in remission: Clinical and neurocognitive correlates
Introduction
In recent years, the concept of quality of life (QoL) has become increasingly relevant in schizophrenia and BD research, since effective treatment from a biopsychosocial perspective is now regarded as the reduction of symptoms without compromising the patients' QoL (Awad et al., 1995). Impairment in QoL has been reported to persist in bipolar patients even when they are euthymic (Michalak et al., 2005, Sierra et al., 2005), and QoL of patients with schizophrenia living in the community is mostly lower than that of healthy subjects (Bengtsson-Tops and Hansson, 1999, Alptekin et al., 2005). In a recent review, relatively better QoL was found in eight of nine studies that directly compared BD with schizophrenia (Dean et al., 2004), with the QoL of BD patients lying on a continuum between those of patients with schizophrenia and healthy subjects. Some authors have suggested that neurocognitive deficits in schizophrenia appear to have a direct effect on the QoL (Jaeger and Douglas, 1992, Lysaker et al., 1995, Alptekin et al., 2005), but some reports failed to confirm this result (Heslegrave et al., 1997, Aksaray et al., 2002).
Studies of patients with BD have demonstrated neurocognitive deficits in many of the same cognitive domains reported in patients with schizophrenia, even while the patients are in remission (Martinez-Arán et al., 2002, Altshuler et al., 2004, Zalla et al., 2004); however, there are few studies focusing on the relationship between cognitive and functional impairments in BD, and specifically comparing remitted bipolar and schizophrenia patients on this issue. The purpose of this cross-sectional study was to examine the relationships between clinical and neuropsychological variables and self-reported QoL in euthymic BD patients as compared with patients with schizophrenia in remission. We hypothesized that longer illness duration, psychopathology, and neurocognitive deficits would be associated with lower self-reported QoL in both patient groups. Moreover, we expected differences in neurocognitive function between patients with BD and patients with schizophrenia, and this in turn would differently affect their QoL, more severe cognitive deficits being associated with a worse QoL.
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Subjects
Study participants aged 18–63 were recruited from the Department of Psychiatry of Santarém's Hospital, and from private practice, and diagnosed according to DSM-IV criteria (American Psychiatric Association, 1994), ascertained from a personal interview by a psychiatrist and by medical chart reviews. Twenty-three bipolar patients were part of the ongoing thesis of one of the authors, and were also screened with the MINI (Mini-International Neuropsychiatric Interview; Sheehan and Lecrubier, 1994
Sociodemographic and clinical characteristics of patient and control groups
The three groups did not differ with respect to age or educational level (Table 1), but differed with respect to gender, the control group having significantly more women (Chi-square = 12.911, P = 0.002).
The patient groups did not differ with respect to age at onset of illness or duration and number of hospital admissions, but they did differ with respect to PANSS sub-scale scores, patients with schizophrenia showing significantly higher scores on all sub-scales compared with BD domains of
Discussion
As previously reported (Hermann et al., 2002), individuals with schizophrenia have impaired neurocognitive functioning and reduced QoL compared with healthy subjects, except on the environmental domain of the WHOQOL-BREF (Alptekin et al., 2005). Consistent with other reports (Leidy et al., 1998, Martinez-Arán et al., 2002, Sierra et al., 2005), the same is true for BD patients, even in the stable phase of the disorder.
Statistically significant differences in cognitive performance between the
Conclusions
The results of this study revealed that euthymic BD patients had substantial impairments in QoL, similar in severity to those of patients with schizophrenia in remission. In patients with schizophrenia, QoL was more strongly related to levels of psychopathology (especially depressive symptoms) than neurocognitive deficits, whereas in BD patients, both psychopathology and neurocognitive deficits were strongly associated with self-reported lower QoL.
Clinical recovery is essential in schizophrenia
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