Therapeutic relationships and quality of life: association of two subjective constructs in schizophrenia patients.

Subjective quality of life is an important criterion in outcome evaluation that has been well-researched in psychiatry. By comparison, the therapeutic relationship which may also be subjectively assessed has been relatively neglected as an outcome criterion although it has predictive power in relation to outcome. This exploratory study investigated subjective quality of life and therapeutic relationships in first-admission (N = 90) and long-term (N = 168) schizophrenia patients, each at two points of time. The follow-up period was 9 months for the first-admission sample and 1.5 years for the long-term sample. A significant relationship was found between global assessments of quality of life and therapeutic relationships in long-term, but not in first-admission patients. This finding was consistent at both assessments, suggesting that therapeutic relationships may become more central to quality of life in long-term care situations and that patients' views of this relationship are increasingly embedded in their overall appraisal of life.

Objective and subjective quality of life of first-admitted women and men with schizophrenia.

Empirical studies have shown that there are differences between women and men with respect to the onset of schizophrenia and the development of their mental and social conditions. It was therefore the goal of this study to assess the objective life situation and subjective quality of life, as well as the differences, similarities and interrelations, at the onset of schizophrenia in women and men. Ninety schizophrenic patients were interviewed between the second and fourth weeks of their first hospital stay using the Berlin Quality of Life Profile, and rated according to the BPRS. Areas of social problems (work, living circumstances, safety and drug abuse) had become manifest with several of the patients, particularly among the young men, prior to first admission. Although objective conditions, gender and psychopathology have an impact on the subjective quality of life, it cannot be fully explained by them. Multivariate analyses have demonstrated that the factors influencing it are probably different for women and men, and schizophrenic women appraise their life circumstances in a different manner from men, as is true for differences between the statements of acutely and chronically ill patients. It can be concluded from the results of this study that psychiatric services should offer specific social support measures before or at first hospital admission and not after the illness has become chronic. The subjective construct of global quality of life apparently differs from one sample to another, and gender-related aspects, among others, have an impact on it.

Do different subjective evaluation criteria reflect distinct constructs?

Four subjective evaluation criteria--self-rated symptoms, subjective quality of life, self-rated needs, and patients' assessment of treatment--were examined to determine whether they reflect distinct constructs and to what extent they are correlated. The four criteria were assessed in 90 newly admitted schizophrenia patients, 170 long-term-hospitalized schizophrenia patients, 154 patients with alcoholism admitted for the short term, and 68 patients with alcoholism in long-term rehabilitation, using identical instruments. The four criteria show substantial intercorrelations, except for assessment of treatment in the two acute treatment groups. One general factor explains between 43% and 55% of the variance in each group. Factor scores are associated with observer-rated psychopathology and objective data. The four criteria overlap in different patient groups, except in the assessment of treatment in acute groups. The use of more than one subjective criterion should occur only with specific hypotheses. A better theoretical framework is needed to explain the differences between and interrelationships of subjective evaluation criteria.

[Initial hospitalization of schizophrenic patients. Illness manifestations, stresses, problems and resources]. / Die erste Hospitalisierung Schizophrener. Beschwerden, Belastungen, Sorgen und Ressourcen.

PURPOSE: In this study we examined subjective views other than the usually studied quality of life, needs and treatment satisfaction, of first-admitted schizophrenic patients. METHODS: Data of 90 patients were gathered with two established and a new questionnaire. RESULTS: Signs of anxious unrest and loss of vigour are the most frequently reported complaints in patients as well as in a sample of the Berlin general population that was also studied but with a clearly higher incidence in the patients. Patients are most often burdened by concerns regarding their disease and their objective living conditions, especially work. They experience social contacts and leisure activities as helpful. CONCLUSIONS: The findings suggest that complaints, burdens, worries and the fear of negative consequences--rather than being an expression of specific schizophrenic symptoms--are a non-specific reaction to a difficult and burdensome situation. In clinical practice, special consideration of this reaction and of the social conditions seems useful.

Does quality of life differ in schizophrenic women and men? An empirical study.

In our study of 617 schizophrenic patients, we tested the hypothesis that women have a better objective and subjective quality of life than men. Better social integration of women was confirmed. Objective conditions had a significant but quantitatively small impact on satisfaction with specific life domains. Better social integration did not, however, lead to more satisfaction among schizophrenic women. Satisfaction with life in general was better predicted by satisfaction in different life domains than by objective circumstances. Predictors of satisfaction with life were not equal for both sexes. Rather than confirming quantitative differences in subjective quality of life, our data support the existence of gender-specific processes and contexts of subjective valuation.

Profiles of subjective quality of life in schizophrenic in- and out-patient samples.

For the use of subjective quality of life as an evaluation criterion, it should be known if measures are reliable, to what extent they are influenced by other variables and whether differences and similarities can be detected across treatment situations. Quality of life profiles (Berliner Lebensqualitatsprofil/Lancashire Quality of Life Profile) of 440 schizophrenic patients (from Berlin, Germany and from Wales, UK) were examined. Reliabilities differed between life domains and groups. The influence of other variables was moderate and varied between the groups. Several significant differences between subsamples could be shown between in-patients with a shorter present stay and out-patients. In addition, interesting similarities in profile patterns between in-patients with a longer stay (> or = 2 years) and out-patients can be found. Being admitted to a psychiatric hospital seems to have an influence on the level and structure of subjective quality of life for some time. Being in a psychiatric hospital for a longer time seems to coincide with a stabilization of level and structure of subjective quality of life. Future reports on subjective quality of life should include diagnostically homogeneous sampling and control the correlation with psychopathology. Further research is needed to clarify the impact of other variables (e.g. length of stay, cognitive variables, treatment features) on patients' satisfaction in different settings.

[Schizophrenia and quality of life--sex-specific aspects]. / Schizophrenie und Lebensqualität--geschlechtsspezifische Aspekte.

Empirical studies show that schizophrenic women and men differ in psychological as well as social characteristics. In women the course of illness and objective life situation seem to be more favourable. In studies on the subjective quality of life in psychiatric patients, gender-specific aspects have hardly been considered so far. Some results indicate that women--contrary to women of the general population--are more content than male psychiatric patients. The systematic inclusion of gender-specific aspects in quality of life studies might clarify how quality of life is influenced in psychiatric patients. It might also contribute to designing psychiatric care in a way that specific sources of satisfaction are made use of.

Response of polygraphic sleep to phenytoin treatment for epilepsy. A longitudinal study of immediate, short- and long-term effects.

Report on a prospective longitudinal study of alterations in polygraphic sleep by phenytoin monotherapy for epilepsy. A first dose of 100mg already caused abbreviation of sleep latency and an increase of slow-wave sleep in the first NREM-REM cycle. In the course of adjustments to steady state, an increase of Stage 3 + 4 sleep in the later REM cycles developed, such that the percentage of slow-wave sleep for the whole night was also augmented, whereas the percentage of light sleep decreased. Sleep structure was affected particularly in the third NREM-REM cycle. With continuing therapy, however, these effects were reversed. The only permanent effect was an abbreviated sleep latency. There were only minimal differences in the response of generalized and of localization-related epilepsies. Serum drug levels had only a very limited influence, seizure control and length of follow-up had no influence on the results. As a collateral finding, a delayed further decrease of epileptic discharges during sleep was observed under long-term conditions in patients who were seizure-free and had been so since adjustment to the steady state.

Influence of therapeutic phenobarbital and phenytoin medication on the polygraphic sleep of patients with epilepsy.

Sleep is a modulator of seizure activity, and many antiepileptic drugs are modulators of sleep. Can influences on sleep organization be involved in antiepileptic drug action, and can these partly account for differences in drug response of various epileptic syndromes? Much more exact data must be collected before these questions can be adequately discussed. The polygraphic sleep of 40 unmedicated epileptic patients was recorded and compared with polygraphy after adjustment to therapeutic steady states of phenobarbital (PB) and phenytoin (DPH) (as sequential sole agents in a crossover design with random sequence). With PB, patients fell asleep more rapidly and had fewer movements, movement arousals, and arousal awakenings, all of which could be beneficial, especially for patients with generalized epilepsy. Light sleep was increased, and REM sleep decreased. The usual sleep pattern was altered, with maximal deep sleep early and maximal REM sleep late in the night. PB seemed to have maximal effect in the first REM cycle. With DPH, sleep onset also came sooner, but light sleep was decreased and deep sleep increased, with no alteration of REM sleep. In contrast to PB, the changes in sleep organization were toward leveling the distribution of deep NREM sleep. The maximal alterations were observed in the third REM cycle. With both drugs, there were some differences in the response of generalized as opposed to focal epilepsies, and of awakening as opposed to sleep epilepsies. Thus, the early REM cycles seemed to be more modifiable by drugs in patients with generalized or awakening epilepsies than in patients with focal or sleep epilepsies.(ABSTRACT TRUNCATED AT 250 WORDS)