Measuring quality of life in first-episode psychosis

Abstract

Quality of life (QoL) measures are increasingly recognized as necessary parts of outcome assessments in psychosis. The present paper is a comprehensive study of patients with first-episode psychosis where QoL is measured by the commonly used Lehman Quality of Life Interview (L-QoLI). The aim is to examine if the L-QoLI maintain its original structure when used in a group of patients with first-episode psychosis, and to investigate what determines global subjective QoL with a specific emphasis on premorbid adjustment, duration of untreated psychosis (DUP) and clinical symptoms. The study indicates that the psychometric properties of the L-QoLI do not change significantly when used in first-episode samples. The patients report subjective and objective QoL in the fair to good range, with only a moderate association between the objective and subjective measures. Poor global satisfaction is predicted by being single, abusing drugs, being depressed, having a diagnosis of psychotic affective disorder, having poor premorbid social adjustment and DUP over 10 weeks. The study supports the notion that patients with first-episode psychosis construct QoL in the same way as other groups, and that longer durations of compromised function at this stage produces poor satisfaction with life rather than a downward readjustment of expectations.

Perceived stress mediates the relationship between social adaptation and quality of life in individuals at ultra high risk of psychosis

“…On the other hand, clinician-administered rating scales may be subject to difficulties in separating out the influence of prevalent symptoms of the illness, such as negative symptoms (Malla & Payne, 2005). Nevertheless, most studies conclude that self-reported satisfaction or subjective QoL is a valid outcome measure in schizophrenia and other psychotic disorders (Melle et al, 2005).…”

“…It has been shown that QoL is lower in UHR individuals than in the healthy population, and worse than in first-episode psychosis (Bechdolf et al, 2005;Domínguez-Martínez et al, 2015;Ruhrmann et al, 2008). Psychopathological symptoms have been the most commonly studied factors (Górna et al, 2008, Melle et al, 2005, and depressive symptoms have the greatest effect on QoL in both patients with first-episode psychosis and UHR individuals (Ohmuro et al, 2017;Ruhrmann et al, 2008).…”

Structural neuroimaging in psychosis: a systematic review and economic evaluation

“…66 This initiative is in response to the evidence base linking the length of untreated psychosis with reduced quality of life and a worse prognosis 6,47,50 and providing intensive, integrated, sustained outreach-based care during a critical period in the course of illness. 65 Despite reported problems with funding and inequities in access, the number of individuals served by early intervention teams increased from ~1000 to 12,000 between 2002 and 2007.…”

“…There are widespread problems with social and sexual relationships and in the performance of activities of daily living. 46 A longer duration of untreated psychosis is correlated with a worse QoL, [47][48][49] worse treatment outcome 50 and worse prognosis. 6 QoL tends to be lower where people with psychosis are single, 51 have psychiatric co-morbidity, 51 poor premorbid adjustment, 49 longer duration of psychotic symptoms 49 and poor social relations and finances.…”

Subjective and objective quality of life at first presentation with psychosis

“…3,4 A number of clinical factors are linked with diminished QOL including depressive symptoms, [5][6][7][8][9] negative symptoms, [7][8][9] premorbid functioning 6,10 and duration of untreated psychosis (DUP). 6,9 However, findings of the clinical characteristics linked with poorer QOL are not consistently replicated which is predominantly due to methodological variation in QOL definitions and perspectives used. Although consensus seems to have been reached that QOL is a multidimensional construct incorporating assessments of multiple life domains, the perspective from which QOL should be viewed has not been unanimously agreed.…”