Depression and functioning are important to subjective quality of life after a first episode psychosis (original) (raw)
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Health-related quality of life and psychiatric comorbidity in first episode psychosis
Comprehensive Psychiatry, 2005
Background: Quality of life (QOL) has been increasingly recognized as an important outcome measure in the care of patients with severe mental illnesses. This study seeks to evaluate the health-related QOL in patients with first episode psychosis and comparing those with psychiatric comorbidity to those without in an Early Psychosis Intervention Program. Methods: Overall, 131 patients with first episode psychosis were evaluated on their principal Axis I diagnosis and any other comorbid diagnosis, severity of psychopathology, insight, social/occupational functioning, and QOL, respectively. Results: Patients with psychiatric comorbidity scored lower on Positive and Negative Symptom Scale positive symptom subscale (z = À2.84, P b .01), had a greater awareness of their mental illness (z = À3.44, P b .001) and its social consequences (z = À3.24, P b 0.001), but lower ratings on the overall QOL (z = À3.06, P b 0.01) as well as in the individual domains (physical, psychological health, social relationships, environment, all P b .05) compared with patients without any psychiatric comorbidity. On multivariate analysis, being single and the presence of psychiatric comorbidity were associated with a poorer QOL in the various subdomains. Conclusions: The association of psychiatric comorbidity with poorer QOL warrants attention. The differences in the clinical correlates may provide potential targets for early identification and highlight needs that are significant to these patients with first episode psychosis and psychiatric comorbidity. D
Depression and quality of life in first-episode psychosis
Comprehensive Psychiatry
Aim: Quality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL. Methods: We assessed 208 individuals with first-episode non-affective psychosis using measures of diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), symptoms (Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning), insight (Birchwood Scale), duration of untreated psychosis (Beiser Scale), and QOL World Health Organisation Quality of Life Instrument (WHOQOL-Bref). We used multiple regression to determine the contribution of depressive symptoms to QOL domains while controlling for sociodemographic and other clinical characteristics. Results: There were complete data for 146 individuals with FEP. Quality-of-life domains were consistently predicted by depressive symptoms including depressive mood and hopelessness rather than biological symptoms of depression with those experiencing more depressive symptoms reporting worse QOL. Those who were treated as in-patients reported improved QOL, and hospitalization was an independent predictor of most QOL domains. In-patients displayed greater levels of positive symptoms with those involuntarily detained displaying greater levels of bizarre behavior, thought disorder, and delusions. Conclusions: These findings suggest that QOL is heavily influenced by depressive symptoms at initial presentation; however, as QOL domains are also influenced by admission status with in-patients being more symptomatic in terms of positive symptoms, subjective QOL assessment may be compromised during the acute phase of illness by both positive and depressive symptom severity.
Subjective and objective quality of life at first presentation with psychosis
Early Intervention in Psychiatry, 2015
Aim: Quality of life (QOL) in firstepisode psychosis (FEP) is impaired when compared to non-clinical controls and several clinical factors including symptoms and untreated psychosis have been linked with poorer QOL. Measurement methods are varied, however, resulting in inconsistent findings and there is a need to simultaneously combine subjective and objective measures of QOL.
Schizophrenia Research, 2005
The concept of quality of life (QoL) is of growing relevance in schizophrenia research. However, there is to date no information on subjective QoL in subjects at risk for a first episode of psychosis in comparison to first episode schizophrenia patients (FE) or healthy controls (HC). Therefore 45 subjects in a putatively early initial prodromal state (EIPS), 40 FE and 45 HC were assessed on demographics, symptoms and subjective QoL as measured by the Modular System for Quality of Life. Results indicated that in most areas HC experienced the highest QoL scores followed in hierarchical order by EIPS and FE. EIPS and FE experienced significantly lower QoL than HC in 5 and 6 of 7 QoL domains. EIPS experienced the lowest ratings in affective QoL. Thus the data demonstrates that subjective QoL in subjects at risk for a first episode of psychosis is substantially reduced when compared with HC and suggests that subjective QoL is already compromised prior to the onset of first positive schizophrenia symptoms. These findings support the notion that subjects at risk for a first episode of psychosis constitute a clinical population for which further service and intervention research is indicated.
Aims: The understanding of factors related to poor subjective quality of life (sQoL) in early psychosis patients is important for both research and treatment efforts. This study examined how sQoL is associated with age at onset of prodromal symptoms, duration of untreated illness (DUI), symptom severity, premorbid functioning and current functional impairment in At-Risk Mental State (ARMS) for psychosis patients. Methods: 40 ARMS patients were assessed for sQoL, symptom severity, premorbid functioning, and social and role functioning. Results: As expected, a large number of significant and negative correlations between sQoL domains and several symptom dimensions emerged, especially for negative symptoms, behavioural change and depression. Poor premorbid functioning in late adolescence was associated with impairments in the psychological health and social relationships domains of sQoL. Current functional impairment was associated with all sQoL domains. Neither age at onset of prodromal symptoms nor DUI were related with sQoL. Conclusions: Findings indicate that different domains of sQoL are differentially and meaningfully associated with symptom severity and functional impairment, suggesting that greater symptom severity and poor functioning are already related with decreased sQoL in the ARMS for psychosis stage. Furthermore, findings highlight the importance of examining functional impairment and affective-motivational symptoms in future research on sQoL in ARMS populations due to their strong relationship with poor sQoL. Finally, findings underscore the importance of addressing the social and occupational dysfunctions already present in early psychosis with psychosocial interventions.
Quality of life as an outcome of psychosis: implications for recovery
Schizophrenia …, 2011
Background: Quality of life (QoL) is an important outcome from a patient's perspective, but remains poorly understood in first episode psychosis (FEP) research. The overall aim of this paper is to describe methodological and conceptual issues associated with QoL as an ...
Comparison of generic and disease-specific measures of quality of life in first-episode psychosis
Journal of Psychiatric Research, 2013
Background: Quality of life (QOL) is now recognised as an important measure of outcome that could potentially influence clinical decision-making for those with a first-episode psychosis (FEP). A number of QOL instruments are available however; many differ in their conceptual orientation which may have serious implications for the outcome of QOL studies, interpretation of findings and clinical utility. We aimed to compare two commonly used tools representing both generic and disease-specific constructs to examine whether both tools appraise the same underlying QOL traits and also whether disease-specific tools retain their psychometric properties when used in FEP groups. Methods: We assessed 159 consecutive individuals presenting with FEP in a defined catchment area with two commonly used QOL tools and examined the findings using the multi-trait multi-method matrix. Results: Similarly named domains of QOL between both tools (Psychological Wellbeing, Physical Health, Social Relations) showed good convergent validity using confirmatory factor analysis. However, discriminant validity was not established given that domains loading onto their indicated latent factors were more strongly correlated with their non-corresponding latent factors. Conclusions: A major consideration in undertaking the present study was to assess the extent to which the outcome of QOL studies in FEP were valid and that systematic error did not provide another plausible explanation for findings. Establishing convergent validity demonstrates that either tool could be used satisfactorily to measure the QOL construct identified however; we did not establish discriminant validity. Doing so would have demonstrated that QOL domains are substantively different in that they contain some unique piece of information determining clinical utility. These findings are important for our understanding of multi-dimensional models of QOL.
Australian & New Zealand Journal of Psychiatry, 2005
Objective: To repor t on the relationship between quality of life (QOL), psychiatric symptoms and neuropsychological functioning in a sample of young people who have experienced a first episode of psychosis 2–3 years following initial presentation. Method: Fifty-one participants aged 15–27 years old completed the short form of the World Health Organization Quality of Life scale (WHOQOL-Brèf), a self-repor t instrument assessing physical, psychological, social and environmental aspects of QOL. A comprehensive neuropsychological batterywas administered. Measures of psychiatric symptoms including depression (as assessed by the Calgary Depression Scale), positive, negative and general psychopathology (as assessed by the Positive and Negative Syndrome Scale) were obtained. Results: Multiple regression analyses were used to evaluate the ability of neuropsychological measures and psychiatric symptoms to predict QOL. When neuropsychological variables were considered on their own, cognitive ...
Psychological well-being among individuals with first-episode psychosis
Early Intervention in Psychiatry, 2010
Aim: Psychological well-being is a subjective component of quality of life (QOL) that has been previously unexplored in individuals recovering from an initial psychotic episode. This study examined predictors of psychological well-being among individuals with first-episode psychosis (FEP) and compared it to a non-clinical college-aged comparison group.