Patient outcomes in schizophrenia I: correlates with sociodemographic variables, psychopathology, and side effects

Objective

The present cross-sectional study examined the relationships of psychopathology, side effects, and sociodemographic factors with treatment outcomes in terms of patients' quality of life (QOL), functioning, and needs for care.

Method

Sixty outpatients with chronic schizophrenia who had been treated with either clozapine or olanzapine for at least 6 months were investigated.

Results

Most psychopathological symptoms as well as psychic side effects, weight gain, and female sex were associated with lower QOL, while cognitive symptoms correlated with better QOL. Female sex, cognitive symptoms, and parkinsonism negatively influenced occupational functioning, and negative symptoms determined a lesser likelihood of living independently. Age, education, depression/anxiety, negative symptoms, and psychic side effects were predictors of patients' needs for care.

Conclusion

Our results highlight the complex nature of patient outcomes in schizophrenia. They reemphasize the need of targeting effectiveness, i.e. both symptomatic improvement as well as drug safety, in such patients.

[The patient's satisfaction in relation with the treatment in hospital psychiatry: a comparison between Italy and Germany]

The aim of this study is to compare psychiatric patients' satisfaction with their treatment in Munich and in South Tirol. For this purpose, besides clinical and social-demographic factors, for each sample-group of patients, their general satisfaction, their valuation of the different aspects of hospital treatment and life quality were considered and compared. The relevance of these elements in the global satisfaction was examined with linear multiple regression models. The results of the research show a rather high level of global satisfaction in both sample-groups, even if statistically relevant differences occur in evaluations of several aspects of the treatment. In Munich's sample-group a higher rate of satisfaction emerged in relation with the treatment: the attitude of the medical staff, the psycho-pharmacological treatments, the clinic's image and the conduct of the nursing staff. In both groups the most relevant factor for patients' satisfaction, besides the positive results of the treatment, was the attitude of the doctor, and in particular way his empathy with the patient. In regard to the age, the diagnosis and the duration of the hospitalization, it was not possible to demonstrate, in both sample-groups, any statistically relevant connection with the general satisfaction rate, while a high rate of trust in the doctors and in the medicines was found to be, in each group, a significant condition for a positive evaluation of the treatment. The influence of the personal life-quality was proven statistically relevant but weak. Altogether, regardless of the medical structure that was examined, the results underline the predominant importance of the curing doctor's social and emotional skills for patients' satisfaction.

Use of alternative/complementary therapy in breast cancer patients--a psychological perspective

The objectives of this study were to assess the additional use of alternative (complementary) therapies in patients with breast cancer who were receiving conventional treatment and to compare patients using alternative therapies with patients receiving only conventional treatment with special reference to psychological adaptation, causal attribution and quality of life. A sample of 117 female out-patients with a diagnosis of breast cancer filled in the following assessment instruments: FQCI (Freiburg Questionnaire for Coping with Illness), PUK (Causal Attribution Questionnaire), EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), POMS (Profile of Mood States), and a self-developed questionnaire on alternative therapies. Nearly half the patients (47%, n = 55) reported that they had used alternative therapies in addition to conventional treatment. The methods applied most frequently were nutrition-related measures (special drinks, vitamin preparations and whole-foods - each applied by about 50% of users), mistletoe preparations (49%), trace elements (47%), and homeopathy (31%). Compared with patients receiving only conventional treatment, the users of alternative therapy were younger and better educated. Users developed a more active style of illness coping than nonusers and showed more religious involvement. Patients using a large number of alternative therapies (>3) tended to adopt a more depressive coping style than those using only a small number (< or =3). For a substantial proportion of cancer patients alternative therapies apparently fulfil an important psychological need. However, a subgroup of patients using many alternative therapies seem to have considerable adjustment problems. In dealing with cancer patients the treatment team should be aware of both these groups.

Quality of life in breast cancer patients--not enough attention for long-term survivors?

In a study of breast cancer survivors, the authors used the European Organization for Research and Treatment of Cancer core questionnaire + breast module (EORTC QLQ-C30/+BR23) and the Functional Assessment of Cancer Therapy-Breast (FACT-B)for the assessment of quality of life (QoL). The main focus of this study was to look at the effect of time elapsed since initial treatment on the patients' QoL. Eighty-seven female patients (average age of 53.9 +/- 8.7 years) were included in the study. All women had received curative cancer therapy. The average time elapsed since start of initial treatment was 4.7 +/- 4.3 years. Reduced QoL, especially in the areas of emotional, social, and sexual functioning, was found not only after initial treatment (1-2 years) but also after long posttreatment survival (> 5 years). From these findings, needs for specific psycho-oncological interventions are derived. The findings imply that besides recovering from the acute consequences of cancer therapy, long-term survivors of breast cancer (> 5 years after initial treatment) still may have a special need for psycho-oncological support.

EORTC QLQ-C30 and FACT-BMT for the measurement of quality of life in bone marrow transplant recipients: a comparison

The purpose of the study was to compare two different quality-of-life self-rating instruments, namely the EORTC QLQ-C30, developed by the quality-of-life study group of the European Organisation for Research and Treatment of Cancer, and the FACT-BMT (version 3), the Functional Assessment of Cancer Therapy - Bone Marrow Transplantation scale, which is the FACT-G(eneral measure) in combination with a module developed specifically for evaluating quality of life of bone marrow transplant (BMT) patients. Fifty-six BMT recipients completed both the EORTC QLQ-C30 and the FACT-BMT (German language version) during the same session. Questionnaire data were analyzed on a subscale basis using correlation analysis and multiple linear regression. Correlations between corresponding subscales of EORTC QLQ-C30 and the FACT-BMT ranged from r=0.30 for the emotional domain (poor agreement) to r=0.77 for global QOL (good agreement). This suggests that the instruments, despite considerable overlap, possibly focus on different aspects of QOL, in particular in addressing emotional and social issues of BMT patients. It appears that the FACT-BMT gives a more comprehensive overview regarding the multidimensional construct of quality of life. The EORTC QLQ-C30 gives more insight into the physical aspects of quality of life and helps to identify symptoms which effectively decrease quality of life from the patient's perspective. The QLQ-C30 might be improved by the incorporation of a BMT-specific module currently under development. We therefore conclude that neither of the two instruments can be replaced by the other in the assessment of QOL of BMT patients and that a direct comparison of results obtained with the two instruments is likely to be misleading.

Time after bone marrow transplantation as an important variable for quality of life: results of a cross-sectional investigation using two different instruments for quality-of-life assessment

Quality of life (QoL) was investigated in 56 BMT recipients. The objective was to compare QoL in terms of physical, emotional, and social functioning between patients within the first year after BMT (n = 15) and patients who were alive more than 1 year after BMT (n=41). The Functional Assessment of Cancer Therapy Scale (FACT-BMT) and the EORTC-Quality of Life Questionnaire (EORTC-QLQ C30) were used to evaluate QoL as perceived by the patients. Results show a significantly reduced general QoL in patients within the first year after BMT. Specific differences were identified on the dimensions of physical and emotional well-being and the symptom scales of appetite loss, fatigue, pain, dyspnea, and nausea and vomiting. QoL improves significantly with time after BMT. We suggest that there should be more integration of QoL expectancy into the pre-BMT information process. Patients should be informed about potential deficits in physical and emotional well-being within the first year after BMT. This could enhance insight and compliance in the critical period early after BMT.

[Psychiatric problems in bone marrow transplantation patients during isolation]

Psychological stress is extremely high in patients with oncological diseases. About 50% of all cancer patients show psychological signs and symptoms which are related to the multiple stress factors of their oncological illness. Although many psychological problems connected with cancer are well known, additional acute stress could result from new therapeutic strategies which require settings similar to intensive care, e.g. bone marrow transplantation. For 2 years the Department of Psychiatry in Innsbruck has provided a "liaison service" at the Department of Bone Marrow Transplantation. Within this observation period, 40 patients have received psychooncological care. The diagnostic distribution according to DSM III-R and specific psychooncological interventions are presented.